None listed
Conditions
Brief summary
Stabilizing the circulation of critically ill patients presenting with severe sepsis or septic can be complicated by a phenomenon called catecholamine hyposensitivity, which leads to a decreased effect of vasoactive drugs. Massive release of endogenous catecholamines like adrenaline and noradrenaline in the setting of sepsis can cause down-regulation and de-sensitization of alpha-1 receptors making the vasculature less responsive to catecholamines. Interestingly, animal studies found that high doses of central alpha2-agonists like clonidine and dexmedetomidine increase vasopressor responsiveness in a septic shock model. In view of the potentially deleterious effects of adrenergic overstimulation and receptor desensitization more research about the effect and use of alpha-2-agonists in clinical doses and critically ill patients is warranted. In the critical care setting, the alpha-2-agonist clonidine has become an established drug for the management of conditions with a high sympathetic activity and it is also commonly used as a supplementary sedative agent. Dexmedetomidine has anaesthetic and analgesic properties and has much higher a2-receptor selectivity than clonidine. Like clonidine, dexmedetomidine is used for sedation in adult critically ill patients. In view of the potential benefits of dexmedetomidine in septic patients, we aim to conduct a retrospective cohort study of the haemodynamic effect of dexmedetomidine compared to standard care sedation in septic patients admitted to the intensive care unit of the Austin Hospital.
Interventions
Mechanically ventilated patients admitted to the intensive care unit with confirmed or suspected sepsis who were treated with dexmedetomidine as a part of their care while admitted to the Austin Hospital between November 2013 and June 2015. All data will be retrieved from the participants medical record and with the duration of the observation period to include the duration of ICU stay and hospital admission.
Sponsors
Austin Hospital
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Aged 18 years or older 2. Subject has been intubated and is receiving mechanical ventilation 3. The treating clinician expects that the patient will remain intubated until the day after tomorrow (unlikely to be extubated the following day). 4. The patient requires immediate ongoing sedative medication for comfort, safety, and to facilitate the delivery of life support measures. 5. Documented site, or strong suspicion of infection with 6. 2 of the 4 clinical signs of inflammation (within the prior 24hours): a) Core temperature greater than 38oC or less than 36oC b) Heart rate greater than 90 bpm c) Respiratory rate greater than 20 bpm, or PaCO2 less than 32 mmHg, or mechanical ventilation d) White cell count greater than 12 x 109/L or less than 4 x 109/L or greater than 10% immature neutrophils 7. Treated with continuous vasopressors or inotropes to maintain a systolic blood pressure greater 90mmHg, or mean arterial blood pressure less than 60mmHg or a MAP target set by the treating clinician for maintaining perfusion 8. Administration of vasopressors or inotropes for greater than or equal to 4 hours and present at time of randomisation
Exclusion criteria
1. Age less than 18 years 2. Patient is pregnant and/or lactating 3. Has been intubated (excluding time spent intubated within an operating theatre or transport) for greater than 12 hours in an intensive care unit 4. Met all inclusion criteria more than 24 hours before study inclusion 5. Patients treated with etomidate 6. Proven or suspected acute primary brain lesion such as traumatic brain injury, intracranial haemorrhage, stroke, or hypoxic brain injury. 7. Proven or suspected spinal cord injury or other pathology that may result in permanent or prolonged weakness 8. Admission as a consequence of a suspected or proven drug overdose or burns. 9. Administration of ongoing neuromuscular blockade 10. Mean arterial blood (MAP) pressure that is less than 50 mmHg despite adequate resuscitation and vasopressor therapy at time of randomisation 11. Heart rate less than 55 beats per minute unless the patient is being treated with a beta-blocker or a high grade atrio-ventricular block in the absence of a functioning pacemaker 12. Known sensitivity to any of the study medications or the constituents of propofol (egg, soya or peanut protein) 13. Acute fulminant hepatic failure 14. Patient has been receiving full time residential nursing care. 15. Death is deemed to be imminent or inevitable during this admission and either the attending physician, patient or substitute decision maker is not committed to active treatment. 16. Patient has an underlying disease that makes survival to 90 days unlikely
Outcome results
None listed