Abstract:
INTRODUCTION:Most anxiolytics and sedative regimens in the intensive care unit (ICU) impair intellectual function, reducing patient autonomy, and often add to patient morbidity. Using an ICU-validated cognitive assessment tool Adapted Cognitive Exam (ACE), we performed a comparison between dexmedetomidine (DEX) and propofol (PRO) to evaluate which sedative regimen offered the least decrement in intellectual capacity. METHODS:This was a prospective, randomized, double-blinded study of 30 awake and intubated brain-injured (BI, n = 18) and non-BI (12) ICU patients. Each patient received fentanyl/PRO and fentanyl/DEX titrated to a calm, awake state using a crossover design. Cognitive testing was performed at each study period using the validated 100-point Hopkins ACE cognitive battery. FINDINGS:Sedation with PRO diminished adjusted ACE scores (100-point exam) by a mean of -12.4 (95% CI -8.3 to -16.5, p < 0.001) while DEX, in contrast, improved ACE scores (6.8, 95% CI 1.2-12.4, p < 0.018). The difference in the change of ACE score between DEX versus PRO, our primary endpoint, was 19.2 (95% CI 12.3-26.1 p < 0.001) in favor of an improved ACE score on DEX. Patients with BI required less sedative, but effects of PRO and DEX on cognition were not changed. No serious adverse events occurred. Modest bradycardia was noted post hoc with DEX (-7.7 bpm, p < 0.01). INTERPRETATION:ICU patients may be offered sedation without necessarily compromising arousal or cognition. Alleviation of anxiety and agitation can singly and effectively improve mental engagement and performance if overt forebrain dysfunction is avoided. Higher ACE scores with DEX may be a consequence of the intellect-sparing yet calming effect of this drug.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Mirski MA,Lewin JJ 3rd,Ledroux S,Thompson C,Murakami P,Zink EK,Griswold Mdoi
10.1007/s00134-010-1874-9subject
Has Abstractpub_date
2010-09-01 00:00:00pages
1505-13issue
9eissn
0342-4642issn
1432-1238journal_volume
36pub_type
临床试验,杂志文章,随机对照试验abstract::As part of a nationwide evaluation of intensive care, we examined patient- and hospital-related factors which could influence the patterns of utilization of arterial cannulae and central venous and pulmonary artery catheters. We also studied the possible impact of these interventions on the short-term outcome among 14...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01713935
更新日期:1991-01-01 00:00:00
abstract::The recording of intratracheal pressure in patients breathing through a tracheostomy tube is marred by methodological problems. In model experiments it has been shown that the introduction of a recording catheter into the tracheostomy tube alters the recorded pressure by as much as 20-40%. To avoid such inaccuracy, a ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01735176
更新日期:1990-01-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
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更新日期:2009-10-01 00:00:00
abstract:OBJECTIVE:To determine the clinical epidemiology of invasive group A streptococcal disease (IGASD) and identify predictors of admissions into an intensive care unit (ICU). DESIGN:A cross-sectional study. SETTING:Retrospective review of data. PATIENTS:A total of 204 patients hospitalized throughout the state of Flori...
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abstract::Type III procollagen N-peptides (PIIINPs) are believed to be released in stoichiometric amounts as type III collagen molecules are secreted from cells. We hypothesized that if the human lung actively produces type III collagen a detectable transpulmonary gradient in PIIINPs would exist in normal individuals that might...
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pub_type: 杂志文章
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pub_type: 杂志文章,评审
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更新日期:1995-09-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
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更新日期:2004-09-01 00:00:00
abstract:: ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-018-5280-z
更新日期:2018-12-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
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更新日期:1990-01-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
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更新日期:1978-01-01 00:00:00
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更新日期:2013-07-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-008-1202-9
更新日期:2008-12-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01725734
更新日期:1982-01-01 00:00:00
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pub_type: 杂志文章
doi:10.1007/s00134-012-2565-5
更新日期:2012-07-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2001-11-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:1993-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:1994-07-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2008-07-01 00:00:00
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journal_title:Intensive care medicine
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更新日期:1993-01-01 00:00:00
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更新日期:2004-12-01 00:00:00
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pub_type: 杂志文章,已发布勘误
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更新日期:2018-05-01 00:00:00
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更新日期:1986-01-01 00:00:00