Mechanical Ventilation Complication
Conditions
Keywords
combined sedation
Brief summary
For the patient who passed the screen of weaning from ventilation, the traditional sedation drug such as propofol and midazolam should be decreased or stopped, then it would induce the stress response and agitation, such as hypertension,tachycardia etc. In order to resolve that problem, the sedation should be given again. but if renewed to sedation, it would cause prolonged sedation and ventilation duration. So as to resolve above issues, after the patient passed the screen of weaning, sedation is changed to Dexmedetomidine, a new sedation drug, that could wake up at any time. So our study to compare the efficacy and safety of sequential sedation of propofol or midazolam and dexmedetomidine in mechanical ventilated ICU patients.
Interventions
DRUGFentanyl
Fentanyl 0.7-1μg/kg，prn pain assessment is done every 4 hours，maintain Behavioral Pain Scale（BPS） 0-2.
PROCEDURESedation assessment
Sedation assessment is done every 4 hours,maintain the Riker Sedation Agitation Score(SAS) 3-4.
PROCEDUREScreen of weaning
1\. Screen of weaning is done at 8:00 every morning. 2 If the patient is successful to wean, stop the Dexmedetomidine sedation. 3. If failed to wean, the patient is ventilated again and try to wean after 24 hours, until it is successful to wean and stop sedation，
DRUGPropofol
Propofol is started with dosage of 0.3 mg/kg/h, observe the patient's response, increase 0.3 mg/kg/h propofol every 10 minutes until target sedation level is obtained(Riker Sedation Agitation Score(SAS) 3-4),then 0.3-3 mg/kg/h propofol is maintained.
DRUGMidazolam
Midazolam 2 mg is slowly titrated to Riker Sedation Agitation Score(SAS) 3-4 every 10 minutes, then Midazolam 0.02-0.1 mg/kg/h is maintained.
DRUGDexmedetomidine
After the screen of the weaning is passed, change to Dexmedetomidine sedation, the dose is 0.2-0.7 mg/kg/h and continuously pumped, increase the dose 0.1-0.2 mg/kg/h every 30 minutes, titrate to Riker Sedation Agitation Score(SAS) 3-4，the maximum dose is 1 mg/kg/h maintained，and prepare for weaning.
Sponsors
Chinese Medical Association
Tianjin Third Central Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Written Informed Consent 2. Anticipated Ventilation and sedation duration of at least 48 hours 3. Age≥18 years old 4. Weight is in the range of ±20% of standard weight.\[Standard weight= (Height(cm)-80)×70﹪ for male and (Height(cm)-70)×60﹪for female\] -
Exclusion criteria
1. Extremely unstable of circulatory system, such as systolic blood pressure less than 90 mm Hg despite continuous infusions of vasopressors before the start of study drug infusion or shock； 2. Heart rate less than 50 bpm 3. Second or third degree heart block 4. Serious central nervous system pathology(acute stroke, uncontrolled seizures,severe dementia) 5. Acute hepatitis or severe liver disease (Child-Pugh class C) 6. Dialysis of all types 7）History of neuromuscular disease 8\) Unstable mental status and metal illness 9) Sure or suspected abuse of narcotics and alcohol independence 10) Allergy to experimental drug and other contraindication 11) Advanced tumor patients 12) Neuromuscular blockade other than for intubation 13) Pregnancy or lactation 14) Patient that participate other trial at past 30 days -
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Ventilation duration | From intubation to weaning from mechanical ventilation, up to 7 days. | The time of intubation and the time of weaning from mechanical ventilation are recorded. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Blood pressure | From the beginning to weaning of sedation, up to 7 days. | blood pressure is recorded. |
| Cost of sedation drug | From the admition to discharge from ICU,up to 28 days. | The cost of sedation drug is calculated. |
| Cost of narcotics | From the admition to discharge from ICU,up to 28 days. | Cost of narcotics is calculated. |
| Delirium | From the beginning of sedation to discharge from ICU, up to 28 days. | Using the Mini-mental State Examination(MMSE) to examine the delirium. |
| Heart rate | From the beginning to weaning of sedation, up to 7 days. | — |
| Respiration Rate | From the beginning to weaning of sedation, up to 7 days. | — |
| Pulse blood oxygen saturation | From the beginning to weaning of sedation, up to 7 days. | — |
| Cost of ICU stay | From the beginning to weaning of sedation, up to 7 days. | — |
Outcome results
None listed