الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Intensive care unit (ICU) patients are routinely provided with analgesia and sedation to prevent pain and anxiety that is mostly caused by invasive techniques in the ICU. The most common of which is mechanical ventilation. MV usually brings stressful, uncomfortable, and even painful experience to ICU patients that may prolong the period of MV with its adverse effects. Therefore, international guidelines recommend routine use of sedation to fully prevent patients from exposure to these adverse stimuli.
An ideal sedative regimen should safely facilitate mechanical ventilation while reducing the duration for which such support is needed, as well as reducing the ICU length of stay, with minimal adverse effects.
Several medications have been used for sedation, midazolam is a benzodiazepine, it has anxiolytic effect, and it acts centrally on GABA receptors producing hypnosis and some amnesia. dexmedetomidine is a highly selective alpha 2 adrenergic agonist received FDA approval in 1999 for use as a short-term sedative analgesic.
The aim of this work was to compare the safety and efficacy of the sedative effect of dexmedetomidine and midazolam in COPD patients on mechanical ventilation.
The present study was conducted on 60 adult patients aged (18-60) years old, admitted to the Critical Care Medicine Department in Alexandria Main University Hospital diagnosed with acute COPD exacerbation on mechanical ventilation.
After approval of the medical ethics committee in Alexandria Main University Hospital an informed written consent was taken from the next of kin.
All patients included in the study were subjected to complete evaluation including history taking, physical examination, neurological examination, necessary laboratory investigation, and radiological investigations.
Patients were divided into two equal groups (30 patients each):
group I: Received dexmedetomidine in the following dose: Loading infusion of
1 mcg/kg over 10 minutes followed by maintenance infusion of (0.2-0,7 ) mcg/ kg/ h.
group II: Received midazolam in the following dose: loading dose of (0,5-5) mg every 1-5 min as needed then continuous infusion at 1-2mg/h.
Patients were treated according to Global Initiative chronic Obstructive Lung Disease guidelines (GOLD guidelines), and weaned from mechanical ventilation according to European respiratory society guidelines till extubation.
The following parameters were measured:
• Vital signs: Heart rate (beats/minutes) Mean arterial blood pressure (MABP) mmHg and Arterial oxygen saturation (SpO2) %, electrocardiogram (ECG), urine output (measured every day during ICU stay).
• Laboratory investigations were recorded day after day.
• The level of sedation was measured daily by Richmond Agitation-Sedation Scale RASS score.
• Time from stopping sedation till extubation
• duration of mechanical ventilation
• length of ICU stay
• Occurrence of any side effects e.g. incidence of VAP, bradycardia, hypotension requiring vasopressor administration, and hepatic impairment.
• Occurrence of delirium using Intensive Care Delirium Screening Checklist (ICDSC).
Results of this study revealed the following:
• There was no significant difference between the two groups as regard age and sex.
• As regard heart rate (HR), mean heart rate was significantly lower in group I than in group II throughout ICU stay.
• As regard mean arterial blood pressure (MABP) and arterial oxygen saturation SO2%, there was no significant difference between the two groups.
• RASS Score show highly significant difference between the two groups, it was a higher score in group II than in group I.