Comparison of sedation with dexmedetomidine versus propofol in mechanically ventilated critically ill adult patients in tertiary level teaching hospital.

Thesis Report.

ABSTRACT:

Background: Patients in intensive care unit setting require invasive monitoring and treatments that often lead to anxiety and pain. To reduce anxiety, increase to tolerance and improve outcome of such interventions, sedation is common practice. Propofol and Dexmedetomidine both are frequently used for sedation in ICU.

Methodology: In a randomized, prospective, open label study, seventy critically ill adulth patients requiring mechanical ventilation were assigned to receive either propofol infusion with 1.2mg/kg/hr or dexmedtomidine infusion with 0.2 mcg/kg/hr starting dose within twelve hour of intubation and titration of study drug to achieve RASS -2 to o until extubation or for seven days whichever is longer. Primary end point was percentage of time within target sedation range and secondary end points were prevalence of delirium, duration of mechanical ventilation and use of fentanyl and haloperiod.

Results: All patients were comparable with respect to age, sex, body mass index, sequential Organ failure Assessment (SOFA) ii and baseline hemodynamic parameters. The percentage of time within target sedation range (Richmond agitation sedation score -2 to 0) was not significantly different between dexmedetomidine (73.01%) group and propofol group (74.09%); p= 0.947. The prevalence of delirium in dexmedetomidine group (22.9%) was not significantly different from propofol group (37.1%); p=0.192 in total study duration but dexmedetomidine had lesser duration of delirium 4.8+_ 11.35 hrs as compared to propofol 17.8 +- 27.51 hrs (p=0.013). Consumption of fentanyl 360mcg [IQR 250-1250] was significantly less in dexmedetomidine group as compared to propofol group 500mcg [IQR 400-650]; p= 0.043. Consumption of haloperidol was also significantly less in dexmedetomidine group 0mg [IQR 0-5] compared to propofol group 5 mg [IQR 0.20]; p= 0.025. Duration of mechanical ventilation in dexmedetomidine group 57.37+_ 15.96 hrs was similar to propofol group 60.6+_ 16.8 hrs; p= 0.413. Ability to communicate pain via visual to propofol group 14(40%); p=0.001. Adverse events like hypotension, bradycardia was not significantly different. Incidence of bradycardia was not significantly different. Incidence of bradycardia was equal in both groups whereas incidence of hypotension in dexmedetomisine group was 24.9% vs propofol group 17.13%.

Conclusion: Sedation with dexemedetomidine was similar as compared to prpofol in mechanically ventilated critically ill adult patients. Dexemedetomidine reduced duration of delirium as well as treatment of delirium with haloperidol. Dexemedetomidine also reduced consumption of fentanyl and improved patient, ability to communicate compared to propofol . Incidence of hypotension and bradycardia were comparable with propofol.

Keywords: Dexemedotomidine, ICU, prolonged mechanical ventilation, Propofol, Sedation.