Effects of sedation with propofol or dexmedetomidine on volume responsiveness in critically ill patients with acute circulatory failure

Abstract

Objective To evaluate the effects of sedation with propofol or dexmedetomidine on volume responsiveness in critically ill patients with acute circulatory failure. Methods Ninety-one critically ill patients with acute circulatory failure, aged 20-90 yr, weighing 40-80 kg, requiring sedation with propofol or dexmedetomidine, of Acute Physiology and Chronic Health Evaluation Ⅱ scores 12-47, of Sequential Organ Failure Assessment scores 1-18, and of NYHA Ⅰ or Ⅱ, were included.The patients were randomly divided into 2 groups using a random number table: propofol group (n=45) and dexmedetomidine group (n=46) . Before and after propofol or dexmedetomidine sedation, when Richmond Agitation Sedation Scale score reached -2 or -1 (BIS value 60-75) (after sedation) , passive leg-raising (PLR) test was performed to evaluate volume responsiveness.An increase in cardiac index (ΔCI) ≥ 10% after PLR was considered to be a positive response, whereas ΔCI<10% after PLR was considered to be a negative response.The patients who presented with negative responses before sedation served as negative volume responsiveness subgroups (N subgroups) , that was PN subgroup and DN subgroup. Results The positive rates of volume responsiveness were 64% (14 cases) and 25% (5 cases) in PN and DN subgroups, respectively.The positive rates of volume responsiveness were significantly higher after sedation than before sedation in PN and DN subgroups.Compared with DN subgroup, the positive rates of volume responsiveness were significantly increased after sedation in PN subgroup. Conclusion For the critically ill patients with acute circulatory failure, both propofol and dexmedetomidine sedation can improve volume responsiveness, and propofol provides better efficacy than dexmedetomidine. Key words: Propofol; Dexmedetomidine; Critical illness; Shock; Fluid therapy