Yoğun Bakım Biriminde Deksmedetomidin Kullanımı Deneyimi: Yapılandırılmış Bir Konsensüs Raporu [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. 2018; 46(3): 176-183 | DOI: 10.5152/TJAR.2018.08058  

Yoğun Bakım Biriminde Deksmedetomidin Kullanımı Deneyimi: Yapılandırılmış Bir Konsensüs Raporu

Daniela Pasero1, Fabio Sangalli2, Massimo Baiocchi3, Ilaria Blangetti4, Sergio Cattaneo5, Gianluca Paternoster6, Marco Moltrasio7, Elisabetta Auci8, Patrizia Murrino9, Francesco Forfori10, Ester Forastiere11, Maria Giovanna De Cristofaro12, Giorgio Deste13, Paolo Feltracco14, Flavia Petrini15, Luigi Tritapepe16, Massimo Girardis17
1Department of Anaesthesia and Intensive Care, AOU Città della Salute e della Scienza, Turin, Italy
2Department of Perioperative Medicine and Intensive Care, Cardiothoracic And Vascular Anaesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy
3Department of Cardiovascular and Thoracic Surgery, University Hospital of Bologna “s. Orsola-malpighi”, Bologna, Italy
4Department of Cardiovascular and Thoracic Surgery, Azienda Ospedaliera Santa Croce E Carle, Cuneo, Italy
5Department of Anaesthesia and Intensive Care Medicine, Aziende Socio Sanitarie Territoriali Papa Giovanni Xxiii, Bergamo, Italy
6Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
7Cardiac Intensive Care Unit, Centro Cardiologico Monzino, Milan, Italy
8Department of Anesthesiology and Intensive Care, S. Maria Della Misericordia Hospital, Udine, Italy
9Department of Anaesthesia and Critical Care Medicine, Aorn Ospedali Dei Colli, Naples, Italy
10Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Pisana, Pisa, Italy
11Department of Anaesthesiology, Regina Elena National Cancer Institute, Rome, Italy
12Department of Emergency Medicine, Cardarelli Hospital, Naples, Italy
13Uoc Anestesia E Rianimazione, Policlinico Casilino, Roma
14Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Italy
15Department of Anaesthesia and Intensive Care, University Hospital of Chieti, Chieti, Italy
16Department of Anaesthesiology and Intensive Care Medicine, Umberto I Hospital, “sapienza” University, Rome, Italy
17Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy

Amaç: Ağrı, ajitasyon ve deliryum (AAD) yönetimi kritik hastalarda halen sorun oluşturmaktadır. Deksmedetomidinin (DEX) farmakolojik özellikleri bu ilacı hafif ve kooperatif bir sedasyon için ideal bir aday yapmakta, ancak uygulama ile ilgili birçok soru cevapsız kalmaktadır. AAD yönetimi ve DEX kullanımında deneyimli 17 yoğun bakım uzmanından alınan bu yapılandırılmış konsensüs, DEX’in klinik uygulamada doğru kullanımı için endikasyonlar sağlamaktadır.

Yöntemler: Modifiye RAND/UCLA uygunluk yöntemi kullanıldı. Önceden tanımlanan dört hasta popülasyonunda klinik senaryolar, önerilen güncel farmakolojik stratejilerle tamamıyla örtüşmemektedir (DEX hariç). Literatür verileri tarandıktan sonra, DEX kullanımının olası avantajları belirlendi ve uzlaşma için oylandı.

Bulgular: Tıbbi hastalarla 3 senaryo, non-invaziv ventilasyon uygulanan akut solunum yetmezliği hastalarıyla 5 senaryo, erken postoperatif dönemde kardiyak cerrahi hastalarıyla 3 senaryo ve aşikar deliryum hastalarıyla 3 senaryo mevcut AAD stratejileriyle zor olarak belirlendi. Bu senaryolarda DEX kullanımı panelistler tarafından, kognitif fonksiyonun korunması, solunum dürtüsündeki etkilerin eksikliği, düşük deliryum indüksiyonu ve analjezi etkileri gibi spesifik farmakolojik özelliklerinden dolayı potansiyel olarak faydalı olarak oylandı.
Sonuç: : Faydaları konusunda kesin veriler halen olmamasına rağmen DEX, farklı senaryolarda ilk basamak sedatif olarak düşünülebilir.
Anahtar Kelimeler: Sedasyon, deliryum, analjezi, yoğun bakım, kritik hastalar

Anahtar Kelimeler: Sedasyon, deliryum, analjezi, yoğun bakım, kritik hastalar


Experienced Use of Dexmedetomidine in the Intensive Care Unit: A Report of a Structured Consensus

Daniela Pasero1, Fabio Sangalli2, Massimo Baiocchi3, Ilaria Blangetti4, Sergio Cattaneo5, Gianluca Paternoster6, Marco Moltrasio7, Elisabetta Auci8, Patrizia Murrino9, Francesco Forfori10, Ester Forastiere11, Maria Giovanna De Cristofaro12, Giorgio Deste13, Paolo Feltracco14, Flavia Petrini15, Luigi Tritapepe16, Massimo Girardis17
1Department of Anaesthesia and Intensive Care, AOU Città della Salute e della Scienza, Turin, Italy
2Department of Perioperative Medicine and Intensive Care, Cardiothoracic And Vascular Anaesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy
3Department of Cardiovascular and Thoracic Surgery, University Hospital of Bologna “s. Orsola-malpighi”, Bologna, Italy
4Department of Cardiovascular and Thoracic Surgery, Azienda Ospedaliera Santa Croce E Carle, Cuneo, Italy
5Department of Anaesthesia and Intensive Care Medicine, Aziende Socio Sanitarie Territoriali Papa Giovanni Xxiii, Bergamo, Italy
6Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
7Cardiac Intensive Care Unit, Centro Cardiologico Monzino, Milan, Italy
8Department of Anesthesiology and Intensive Care, S. Maria Della Misericordia Hospital, Udine, Italy
9Department of Anaesthesia and Critical Care Medicine, Aorn Ospedali Dei Colli, Naples, Italy
10Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Pisana, Pisa, Italy
11Department of Anaesthesiology, Regina Elena National Cancer Institute, Rome, Italy
12Department of Emergency Medicine, Cardarelli Hospital, Naples, Italy
13Uoc Anestesia E Rianimazione, Policlinico Casilino, Roma
14Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Italy
15Department of Anaesthesia and Intensive Care, University Hospital of Chieti, Chieti, Italy
16Department of Anaesthesiology and Intensive Care Medicine, Umberto I Hospital, “sapienza” University, Rome, Italy
17Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy

Objective: Management of pain, agitation and delirium (PAD) remains to be a true challenge in critically ill patients. The pharmacological proprieties of dexmedetomidine (DEX) make it an ideal candidate drug for light and cooperative sedation, but many practical questions remain unanswered. This structured consensus from 17 intensivists well experienced on PAD management and DEX use provides indications for the appropriate use of DEX in clinical practice.
Methods: A modified RAND/UCLA appropriateness method was used. In four predefined patient populations, the clinical scenarios do not properly cope by the current recommended pharmacological strategies (except DEX), and the possible advantages of DEX use were identified and voted for agreement, after reviewing literature data.
Results: Three scenarios in medical patients, five scenarios in patients with acute respiratory failure undergoing non-invasive ventilation, three scenarios in patients with cardiac surgery in the early postoperative period and three scenarios in patients with overt delirium were identified as challenging with the current PAD strategies. In these scenarios, the use of DEX was voted as potentially useful by most of the panellists owing to its specific pharmacological characteristics, such as conservation of cognitive function, lack of effects on the respiratory drive, low induction of delirium and analgesia effects.
Conclusion: DEX might be considered as a first-line sedative in different scenarios even though conclusive data on its benefits are still lacking.

Keywords: Sedation, delirium, analgesia, intensive care, critically ill patients


Daniela Pasero, Fabio Sangalli, Massimo Baiocchi, Ilaria Blangetti, Sergio Cattaneo, Gianluca Paternoster, Marco Moltrasio, Elisabetta Auci, Patrizia Murrino, Francesco Forfori, Ester Forastiere, Maria Giovanna De Cristofaro, Giorgio Deste, Paolo Feltracco, Flavia Petrini, Luigi Tritapepe, Massimo Girardis. Experienced Use of Dexmedetomidine in the Intensive Care Unit: A Report of a Structured Consensus. Turk J Anaesthesiol Reanim. 2018; 46(3): 176-183

Sorumlu Yazar: Massimo Girardis, Italy


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