Yoğun bakım hastalarında deksmedetomidin infüzyonunun oksijen ve enerji tüketimi üzerine olan etkisi
Küçük Resim Yok
Tarih
2005
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Anksiyete, mekanik ventilasyon uygulanan yoğun bakım hastalarında oksijen ve enerji tüketimini artırarak olumsuz etkiler gösterebilir. Selektif alfa-2 agonist etkili sedatif olan deksmedetomidinin bu duruma etkileri daha önce çalışılmamıştır. Bu çalışmada mekanik ventilasyon uygulanan yoğun bakım hastalarında deksmedetomidinin oksijen ve enerji tüketimi üzerindeki etkileri indirekt kalorimetri ile araştırılmıştır. Gereç ve Yöntem: Her hasta kendisinin kontrol grubu olarak planlandı. Deksmedetomidin infüzyonu öncesi tüm parametrelerin başlangıç değerleri kaydedildi. Daha sonra 1µg/kg bolus ve 0.2-0.7 µg/kg/ saat şeklinde deksmedetomidin infüzyonu başlandı. Sedasyon iki saat boyunca BİS ile orta düzeyde sedasyon olacak şekilde ayarlandı. Çalışma boyunca BİS skorlarının 60-70 arasında tutulması hedeflendi. Deksmedetomidin infüzyonu uygulanan 2 saat boyunca oksijen tüketimi (VO2), karbondioksit üretimi (VCO2), enerji tüketimi (ET) değerleri indirekt kalorimetri yöntemiyle ölçüldü. Deksmedetomidin infüzyonu durdurulduktan sonraki 1., 2. ve 3. saatteki ölçümler tekrarlanarak çalışma sonlandırıldı. Bulgular: Çalışmaya 15 hasta katıldı. Ortalama yaş 48±16 yıl, ortalama APACHE II skoru 14.8±6.2'di. Deksmedetomidin infüzyonu sırasında VO2, VCO2 ve ET başlangıç değerlerle karşılaştırıldığında anlamlı derecede azaldı (p<0.05). İlaç infüzyonu durdurulduktan sonra tüm değerler başlangıç değerlerine yaklaştı. Sonuç: Yoğun bakım hastalarında deksmedetomidin infüzyonunun metabolik stres cevabını etkileyebileceği ve sedasyonun kesilmesi ile birlikte oksijen ve enerji tüketiminde artışların olabileceği sonucuna varıldı. Anahtar Kelimeler: Yoğun bakım, sedasyon, deksmedetomidin, oksijen tüketimi, enerji tüketimi
Objective: Anxiety may have deleterious effects by increasing oxygen consumption and energy expenditure in mechanically ventilated patients. The effects of Dexmedetomidine, a selective alpha-2 receptor agonist type of sedative, have not been studied in critically ill patients in this respect. In this study, the effects of dexmedetomidine on oxygen consumption and energy expenditure were investigated by indirect calorimetry in mechanically ventilated critically ill patients. Material and Methods: Each patient served as his / her own control. Baseline values of all parameters were recorded before dexmedetomidine infusion. Then, dexmedetomidine infusion was started at a dose of 0.2-0.7 µg/kg/h following a bolus dose of 1 µg/kg. Sedation was adjusted to moderate sedation according to bispectral index (BIS) score for 2 hours. It was aimed to be keep the BIS score between 60-70 during the study. Oxygen consumption (VO2), carbon dioxide production (VCO2), and energy expenditure (EE) were measured by indirect calorimetry method for 2 hours during dexmedetomidine infusion. After the dexmedetomidine infusion was stopped, and the measurements were repeated at the 1st, 2nd and 3rd hour, and the study was terminated. Results: Fifteen patients were included in the study. Mean age was 48±16 years and mean APACHE II score was 14.8±6.2. VO2, VCO2 and EE significantly decreased during dexmedetomidine infusion (p<0.05). After the discontinuation of dexmedetomidine infusion, all values approached to initial values. Conclusion: We conclude that dexmedetomidine infusion may affect metabolic stress response in critically ill patients and there may be increases in oxygen consumption and energy expenditure with the discontinuation of sedation. Keywords: Dexmedetomidine, energy expenditure, intensive care, oxygen consumption, sedation
Objective: Anxiety may have deleterious effects by increasing oxygen consumption and energy expenditure in mechanically ventilated patients. The effects of Dexmedetomidine, a selective alpha-2 receptor agonist type of sedative, have not been studied in critically ill patients in this respect. In this study, the effects of dexmedetomidine on oxygen consumption and energy expenditure were investigated by indirect calorimetry in mechanically ventilated critically ill patients. Material and Methods: Each patient served as his / her own control. Baseline values of all parameters were recorded before dexmedetomidine infusion. Then, dexmedetomidine infusion was started at a dose of 0.2-0.7 µg/kg/h following a bolus dose of 1 µg/kg. Sedation was adjusted to moderate sedation according to bispectral index (BIS) score for 2 hours. It was aimed to be keep the BIS score between 60-70 during the study. Oxygen consumption (VO2), carbon dioxide production (VCO2), and energy expenditure (EE) were measured by indirect calorimetry method for 2 hours during dexmedetomidine infusion. After the dexmedetomidine infusion was stopped, and the measurements were repeated at the 1st, 2nd and 3rd hour, and the study was terminated. Results: Fifteen patients were included in the study. Mean age was 48±16 years and mean APACHE II score was 14.8±6.2. VO2, VCO2 and EE significantly decreased during dexmedetomidine infusion (p<0.05). After the discontinuation of dexmedetomidine infusion, all values approached to initial values. Conclusion: We conclude that dexmedetomidine infusion may affect metabolic stress response in critically ill patients and there may be increases in oxygen consumption and energy expenditure with the discontinuation of sedation. Keywords: Dexmedetomidine, energy expenditure, intensive care, oxygen consumption, sedation
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation, Bilinçli sedasyon, Conscious sedation, Maksimal oksijen tüketimi, Maximal oxygen consumption
