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Dexmedetomidina vs midazolam o propofol para la sedación durante la ventilación mecánica prolongada: dos ensayos
Stephan M Jakob1, Esko Ruokonen, R Michael Grounds
1Department of Intensive Care Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
JAMA
|March 23, 2012
Resumen
La dexmedetomidina es una alternativa segura para la sedación en UCI, no inferior al midazolam o al propofol. Redujo la duración de la ventilación mecánica y mejoró la comunicación del paciente, aunque con más efectos adversos.
Área de la Ciencia:
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Farmacología Farmacología.
- Anestesiología Anestesiología.
Sus antecedentes:
- La sedación a largo plazo en UCI con midazolam o propofol está relacionada con efectos adversos.
- La dexmedetomidina, un agonista alfa-2, ofrece beneficios potenciales para la sedación de la UCI, incluida la reducción de la duración de la ventilación y la mejora de la comodidad del paciente.
Objetivo del estudio:
- Evaluar la eficacia de la dexmedetomidina frente al midazolam y el propofol para mantener la sedación.
- Para evaluar el impacto de la dexmedetomidina en la duración de la ventilación mecánica y la interacción del paciente.
- Para comparar los perfiles de seguridad de la dexmedetomidina, el midazolam y el propofol en la UCI.
Principales métodos:
- Se llevaron a cabo dos ensayos multicéntricos, aleatorizados, doble ciego de fase 3 (MIDEX y PRODEX).
- Los pacientes adultos de UCI que requieren ventilación mecánica prolongada recibieron dexmedetomidina, midazolam o propofol para una sedación de leve a moderada.
- Los resultados clave incluyeron el tiempo en la sedación objetivo, la duración de la ventilación mecánica y la capacidad de comunicación del paciente (VAS).
Principales resultados:
- La dexmedetomidina demostró no ser inferior al midazolam y al propofol en el mantenimiento de los niveles de sedación objetivo.
- Se observó una duración más corta de la ventilación mecánica con dexmedetomidina en comparación con el midazolam (P=.03) pero no con el propofol (P=.24).
- Los pacientes que recibieron dexmedetomidina mostraron una mejor capacidad para comunicar el dolor (puntuaciones VAS) en comparación con el midazolam y el propofol (P<.001).
- La hipotensión y la bradicardia fueron más frecuentes con dexmedetomidina que con midazolam.
Conclusiones:
- La dexmedetomidina es una alternativa viable para la sedación de ventilación mecánica prolongada en las UCI.
- Ofrece ventajas para reducir la duración de la ventilación y mejorar la comunicación del paciente.
- El aumento de la incidencia de hipotensión y bradicardia requiere un monitoreo cuidadoso cuando se usa dexmedetomidina.
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