Abstract
Objective To probe into the influence of dexmedetomidine (DEX) on diaphragm function and postoperative outcomes of mechanically ventilated patients in the intensive care unit (ICU). Methods 84 patients with mechanical ventilation (MV) in the ICU of our hospital were selected as the research participants, including 38 patients in the control group (CG) sedated with midazolam (MZ) and 46 patients in the research group (RG) with DEX sedation. Ramsay sedation score, visual analogue scale (VAS), and restlessness score (RS) were used to evaluate their state before sedation (T0), as well as 2 h (T1), 6 h (T2), and 24 h (T3) after sedation, and the alterations of mean arterial pressure (MAP) and heart rate (HR) were recorded. Serum cortisol (Cor), adrenocorticotropic hormone (ACTH), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin- (IL-) 1β, IL-6, and tumor necrosis factor-α (TNF-α) were measured before and 24 h after sedation. The end-inspiratory diaphragm thickness (DTei) and end-expiratory diaphragm thickness (DTee) were measured within 2 h after the initiation of MV and 5 min after the spontaneous breathing test (SBT), and the diaphragm thickening fraction (DTF) was calculated. Finally, the ventilator weaning, MV time, and the incidence of adverse reactions (ADs) of the two groups were counted. Results T0 and T3 witnessed no distinct difference in Ramsay, VAS, and RS scores between the two arms (P > 0.05), but at T1 and T2, RG had better sedation state and lower VAS and RS scores than CG (P < 0.05), with more stable vital signs (P < 0.05). After sedation, the contents of oxidative stress and inflammatory factors in RG were lower, while DTee, DTei, and DTF were higher, versus CG (P < 0.05). Moreover, RG presented higher success rate of first ventilator weaning, less MV time, and lower incidence of ADs than CG (P < 0.05). Conclusions DEX is effective in mechanically ventilated patients in the ICU, which can protect patients against diaphragm function damage, improve the success rate of ventilator weaning, and benefit the postoperative outcome, with excellent and rapid sedation effect and less stress damage to patients.
Highlights
Most of the patients transferred to the intensive care unit (ICU) are in critical condition, and these patients are usually accompanied by organ failure of different degrees, among which the most common manifestation is decreased and disordered respiratory function [1]
(4) oxidative stress (OSR): before and after 24 h after sedation, 4 milliliters of venous blood were sampled from patients into coagulation-promoting tubes, which were left at ambient temperature for 30 min and centrifuged to obtain serum, for the determination of cortisol (Cor), adrenocorticotropic hormone (ACTH), superoxide dismutase (SOD), and malondialdehyde (MDA) by ELISA
In research group (RG), mean arterial pressure (MAP) and heart rate (HR) were similar at T1, T2, and T3, which were all lower than those at T0 (P < 0.05), while in control group (CG), MAP and HR at T1 were lower than T0 and even lower at T2 (P < 0.05), and there was no difference between T3 and T2 (P > 0.05)
Summary
Most of the patients transferred to the intensive care unit (ICU) are in critical condition, and these patients are usually accompanied by organ failure of different degrees, among which the most common manifestation is decreased and disordered respiratory function [1]. E use of MV can effectively ensure the normal breathing of patients and prevent serious respiratory diseases caused by hypoxia injury and carbon dioxide accumulation [3]. DEX, as a stable and safe sedative drug, is extensively applied in various clinical general anesthesia operations, and has gradually demonstrated its excellent effect in MV [13, 14]. We found that currently, the application of DEX and sedation of patients with MV are usually limited to monitoring the alteration of patients’ real-time vital signs, while ignoring their postoperative outcomes. Diaphragmatic dysfunction (DD) is a common adverse reaction after sedation, and it is one of the key factors leading to adverse outcomes after operation [15]. e related research on DEX and diaphragm function of patients is relatively rare
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