Baptiste Deletombe1, Thibaut Trouve-Buisson1, Alexandre Godon1, Dominique Falcon1, Lise Giorgis-Allemand2, Pierre Bouzat3, Jean-Luc Bosson4, Jean-Francois Payen5. 1. Department of Anaesthesiology and Critical Care, Grenoble Alpes University Hospital, 38000 Grenoble, France. 2. INSERM, Clinical Research Centre 1406, 38000 Grenoble, France; Grenoble Alpes University, Clinical Research Centre 1406, 38000 Grenoble, France. 3. Department of Anaesthesiology and Critical Care, Grenoble Alpes University Hospital, 38000 Grenoble, France; INSERM, U1216, 38000 Grenoble, France; Grenoble Alpes University, Grenoble Institut Neurosciences (GIN), 38000 Grenoble, France. 4. INSERM, Clinical Research Centre 1406, 38000 Grenoble, France; Grenoble Alpes University, Clinical Research Centre 1406, 38000 Grenoble, France; Grenoble Alpes University, CNRS, TIMC, IMAG UMR, 5525-ThEMAS, 38000 Grenoble, France. 5. Department of Anaesthesiology and Critical Care, Grenoble Alpes University Hospital, 38000 Grenoble, France; INSERM, U1216, 38000 Grenoble, France; Grenoble Alpes University, Grenoble Institut Neurosciences (GIN), 38000 Grenoble, France. Electronic address: jfpayen@univ-grenoble-alpes.fr.
Abstract
BACKGROUND: Although non-invasive ventilation (NIV) is recommended in patients with chest trauma, this procedure may expose to discomfort and even failure due to agitation or excessive pain. We tested the impact of dexmedetomidine on the duration of the first session of NIV. METHODS: This randomised, crossover study enrolled 19 patients with blunt chest trauma who needed NIV. During one cycle comprising two NIV sessions, patients received in a random order an intravenous infusion of dexmedetomidine (0.7mcg/kg/h) and placebo (saline solution) that was initiated 60min prior to NIV. Dexmedetomidine (or placebo) was titrated to maintain a Richmond Agitation Sedation Scale (RASS) score between 0 and -3. A 6-h washout period was observed between NIV sessions. The reproducibility of the drug-related effects was tested during a second cycle of two NIV sessions. RESULTS: During the first cycle, dexmedetomidine prolonged the duration of NIV compared to placebo: 280min (118-450) (median, 25-75th quartiles) versus 120min (68-287) respectively, corresponding to a median increased duration of 96min (12-180) (P=0.03). Dexmedetomidine was associated with a lower score for RASS: -0.8 (-1.0;0.0) versus 0.0 (-0.5;0.0) (P<0.01), and reduced respiratory discomfort according to the 10cm visual similar scale: 0.6cm (0.0-3.0) versus 2.2cm (0.0-5.3) (P=0.05). Pain scores, morphine consumption, and blood gas measurements were comparable between groups. No difference in the duration of non-invasive ventilation was found during the second cycle. CONCLUSIONS: In this pilot trial, dexmedetomidine could facilitate the acceptance of the first session of non-invasive ventilation for patients with chest trauma.
RCT Entities:
BACKGROUND: Although non-invasive ventilation (NIV) is recommended in patients with chest trauma, this procedure may expose to discomfort and even failure due to agitation or excessive pain. We tested the impact of dexmedetomidine on the duration of the first session of NIV. METHODS: This randomised, crossover study enrolled 19 patients with blunt chest trauma who needed NIV. During one cycle comprising two NIV sessions, patients received in a random order an intravenous infusion of dexmedetomidine (0.7mcg/kg/h) and placebo (saline solution) that was initiated 60min prior to NIV. Dexmedetomidine (or placebo) was titrated to maintain a Richmond Agitation Sedation Scale (RASS) score between 0 and -3. A 6-h washout period was observed between NIV sessions. The reproducibility of the drug-related effects was tested during a second cycle of two NIV sessions. RESULTS: During the first cycle, dexmedetomidine prolonged the duration of NIV compared to placebo: 280min (118-450) (median, 25-75th quartiles) versus 120min (68-287) respectively, corresponding to a median increased duration of 96min (12-180) (P=0.03). Dexmedetomidine was associated with a lower score for RASS: -0.8 (-1.0;0.0) versus 0.0 (-0.5;0.0) (P<0.01), and reduced respiratory discomfort according to the 10cm visual similar scale: 0.6cm (0.0-3.0) versus 2.2cm (0.0-5.3) (P=0.05). Pain scores, morphine consumption, and blood gas measurements were comparable between groups. No difference in the duration of non-invasive ventilation was found during the second cycle. CONCLUSIONS: In this pilot trial, dexmedetomidine could facilitate the acceptance of the first session of non-invasive ventilation for patients with chest trauma.
Authors: D Longrois; F Petitjeans; O Simonet; M de Kock; M Belliveau; C Pichot; Th Lieutaud; M Ghignone; L Quintin Journal: Rom J Anaesth Intensive Care Date: 2021-01-04
Authors: Dan Longrois; Fabrice Petitjeans; Olivier Simonet; Marc de Kock; Marc Belliveau; Cyrille Pichot; Thomas Lieutaud; Marco Ghignone; Luc Quintin Journal: Rev Bras Ter Intensiva Date: 2022-01-24
Authors: Habib Mr Karim; Irena Šarc; Camilla Calandra; Savino Spadaro; Bushra Mina; Laura D Ciobanu; Gil Gonçalves; Vania Caldeira; Bruno Cabrita; Andreas Perren; Giuseppe Fiorentino; Tughan Utku; Edoardo Piervincenzi; Mohamad El-Khatib; Nilgün Alpay; Rodolfo Ferrari; Mohamed Ea Abdelrahim; Haitham Saeed; Yasmin M Madney; Hadeer S Harb; Nicola Vargas; Hilmi Demirkiran; Pradipta Bhakta; Peter Papadakos; Manuel Á Gómez-Ríos; Alfredo Abad; Jaber S Alqahtani; Vijay Hadda; Subrata K Singha; Antonio M Esquinas Journal: Indian J Crit Care Med Date: 2022-08