Xuemin Wang1, Junhui Ji, Liang Fen, Aizhong Wang. 1. Intensive Care Unit, Shanghai Sixth People's Hospital, Medical College of Shanghai Jiaotong University , Shanghai , PR China .
Abstract
STUDY OBJECTIVE: To examine the effect of dexmedetomidine on CBF in critical ill patients with or without TBI. RESEARCH DESIGN: Prospective controlled trial (ISRCTN57998533). METHODS:Fifteen patients without TBI and 20 patients with TBI with a Glasgow Coma Scale score of 4-14 were assigned to CON or TBI groups, respectively. All patients received 1 μg kg(-1) dexmedetomidine infused over 10 minutes, followed by a 0.4 μg kg(-1)h(-1) continuous infusion for 60 minutes. Blood pressure was maintained at the pre-sedation level with dopamine for all patients. The CBF and cerebral metabolic rate equivalent (CMRe) were measured before sedation and 70 minutes after dexmedetomidine administration. RESULTS:Dexmedetomidine administration significantly decreased CBF in patients of the CON group (difference = 3.3 ml s(-1), 95% confidence interval [CI] = 0.92-5.7 ml s(-1), p = 0.008), without altering the CMRe and CMRe/CBF ratio. The dexmedetomidine-induced change of CBF, CMRe and CMRe/CBF was not significant in the TBI group. The percentage of CBF reduction was greater in the CON group than in the TBI group (difference = 13.9%, 95% CI = 5.5-22.2%, p = 0.002). CONCLUSIONS:Dexmedetomidine may be used in patients with TBI without risk of affecting brain oxygenation.
RCT Entities:
STUDY OBJECTIVE: To examine the effect of dexmedetomidine on CBF in critical ill patients with or without TBI. RESEARCH DESIGN: Prospective controlled trial (ISRCTN57998533). METHODS: Fifteen patients without TBI and 20 patients with TBI with a Glasgow Coma Scale score of 4-14 were assigned to CON or TBI groups, respectively. All patients received 1 μg kg(-1) dexmedetomidine infused over 10 minutes, followed by a 0.4 μg kg(-1)h(-1) continuous infusion for 60 minutes. Blood pressure was maintained at the pre-sedation level with dopamine for all patients. The CBF and cerebral metabolic rate equivalent (CMRe) were measured before sedation and 70 minutes after dexmedetomidine administration. RESULTS:Dexmedetomidine administration significantly decreased CBF in patients of the CON group (difference = 3.3 ml s(-1), 95% confidence interval [CI] = 0.92-5.7 ml s(-1), p = 0.008), without altering the CMRe and CMRe/CBF ratio. The dexmedetomidine-induced change of CBF, CMRe and CMRe/CBF was not significant in the TBI group. The percentage of CBF reduction was greater in the CON group than in the TBI group (difference = 13.9%, 95% CI = 5.5-22.2%, p = 0.002). CONCLUSIONS:Dexmedetomidine may be used in patients with TBI without risk of affecting brain oxygenation.
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