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sábado, 15 de abril de 2017

Alfa2 agonistas en UCI / Alpha-2 agonists in ICU

Abril 15, 2017. No. 2660

Sedación de pacientes en ventilación mecánica en UCI

Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis.

Zhang Z1, Chen K2, Ni H2, Zhang X2, Fan H2.

Sci Rep. 2017 Mar 21;7:44979. doi: 10.1038/srep44979.

Abstract

Sedatives are commonly used for mechanically ventilated patients in intensive care units (ICU). However, a variety of sedatives are available and their efficacy and safety have been compared in numerous trials with inconsistent results. To resolve uncertainties regarding usefulness of these sedatives, we performed a systematic review and network meta-analysis.

Compared with dexmedetomidine, midazolam was associated with significantly increased risk of delirium (OR: 2.47; 95% CI: 1.17-5.19). Our study shows that dexmedetomidine has potential benefits in reducing duration of MV and lowering the risk of delirium.

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Alfa2 agonistas para sedación de adultos en ventilación mecánica en UCI. Revisión sistemática

Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review.

Cruickshank M1, Henderson L1, MacLennan G1, Fraser C1, Campbell M1, Blackwood B2, Gordon A3, Brazzelli M1.

Health Technol Assess. 2016 Mar;20(25):v-xx, 1-117. doi: 10.3310/hta20250.

Abstract

BACKGROUND: Care of critically ill patients in intensive care units (ICUs) often requires potentially invasive or uncomfortable procedures, such as mechanical ventilation (MV). Sedation can alleviate pain and discomfort, provide protection from stressful or harmful events, prevent anxiety and promote sleep. Various sedative agents are available for use in ICUs. In the UK, the most commonly used sedatives are propofol (Diprivan(®), AstraZeneca), benzodiazepines [e.g. midazolam (Hypnovel(®), Roche) and lorazepam (Ativan(®), Pfizer)] and alpha-2 adrenergic receptor agonists [e.g. dexmedetomidine (Dexdor(®), Orion Corporation) and clonidine (Catapres(®), Boehringer Ingelheim)]. Sedative agents vary in onset/duration of effects and in their side effects. The pattern of sedation of alpha-2 agonists is quite different from that of other sedatives in that patients can be aroused readily and their cognitive performance on psychometric tests is usually preserved. Moreover, respiratory depression is less frequent after alpha-2 agonists than after other sedative agents.

CONCLUSIONS: Evidence on the use of clonidine in ICUs is very limited. Dexmedetomidine may be effective in reducing ICU length of stay and time to extubation in critically ill ICU patients. Risk of bradycardia but not of overall mortality is higher among patients treated with dexmedetomidine. Well-designed RCTs are needed to assess the use of clonidine in ICUs and identify subgroups of patients that are more likely to benefit from the use of dexmedetomidine.

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