Experience in the use of dexmedetomidine for sedation in patients with pneumonia in the intensive care unit

Abstract. The experience of using dexmedetomedine for sedation with respiratory disorders of varying severity has been known for a long time. This article examined two clinical cases in which dexmedetomedine was used for connection and adaptation of patients to mechanical ventilation of lungs. The purpose of the work is evaluation of the effectiveness and depth of sedation with varying degrees of respiratory failure, as well as the effect of dexmedetomedine on respiration.

Keywords: dexmedetomidine, artificial lung ventilation, pneumonia, sedation.

Authors:

Dmytriiev D. V., Bortnik D. I., Dmytriieva K. Yu., Melnichenko M. O., National Pirogov Memorial Medical University, Vinnytsia

Literature:

  1. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine [Internet]. Elsevier BV; 2020 May;8(5):475–81. Available from: https://doi.org/10.1016/s2213–2600(20)30079–5
  2. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA [Internet]. American Medical Association (AMA); 2020 Mar 17;323(11):1061. Available from: https:// doi.org/10.1001/jama.2020.1585
  3. Precedex (dexmedetomidine hydrochloride) injection. For intravenous use. — Prescribing information. LakeForest, IL, USA: HospiraInc. 2011.
  4. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The Efficacy of Dexmedetomidine Versus Morphine for Postoperative Analgesia After Major Inpatient Surgery. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2004 Jan;153–8. Available from: https://doi. org/10.1213/01.ane.0000 093225.39866.75
  5. Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Critical Care Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2002 Jan;30(1):119–41. Available from: https://doi.org/ 10.1097/00003246–200201000– 00020
  6. Riker RR. Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients<subtitle>A Randomized Trial</subtitle>. JAMA [Internet]. American Medical Association (AMA); 2009 Feb 4;301(5):489. Available from: https://doi.org/10.1001/jama.2009.56
  7. Ely EW. Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit. JAMA [Internet]. American Medical Association (AMA); 2004 Apr 14;291(14):1753. Available from: https://doi.org/10.1001/jama.291.14.1753
  8. Frontera JA. Delirium and sedation in the ICU. neurocritical care. 2011 Jun 1;14(3):463–74.
  9. Sanders RD, Maze M. Contribution of sedative-hypnotic agents to delirium via modulation of the sleep pathway. Canadian Journal of Anesthesia/Journal canadien d’anesth sie [Internet]. Springer Science and Business Media LLC; 2010 Dec 18;58(2):149–56. Available from: https://doi.org/10.1007/s12630–010–9421–2
  10. Borbely AA, Achermann P. Ultradian dynamics of sleep after a single dose of benzodiazepine hypnotics. European Journal of Pharmacology [Internet]. Elsevier BV; 1991 Mar;195(1):11–8. Available from: https://doi.org/10.1016/0014–2999(91)90376–2
  11. Huupponen E, Maksimow A, Lapinlampi P, S rkel M, Saastamoinen A, Snapir A, et al. Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep. Acta Anaesthesiologica Scandinavica [Internet]. Wiley; 2008 Feb;52(2):289–94. Available from: https://doi.org/10.1111/j.1399–6576.2007.01537.x
  12. Riker RR. Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients A Randomized Trial, JAMA [Internet]. American Medical Association (AMA); 2009 Feb 4;301(5):489. Available from: https://doi. org/10.1001/jama.2009.56
  13. Yuen VM, Hui TW, Irwin MG, Yuen MK. A Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Anesthesia: A Double-Blinded Randomized Controlled Trial. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2008 Jun;106(6):1715–21. Available from: https://doi.org/10.1213/ ane.0b013e 31816c8929
  14. Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Critical Care. 2000 Oct;4(5):302–308.