Use of Dexmedetomidine to Facilitate Extubation in Surgical ICU Patients Who Failed Previous Weaning Attempts
Status:
Terminated
Trial end date:
2012-12-01
Target enrollment:
Participant gender:
Summary
Mechanical ventilation commonly is associated with patient agitation requiring sedation to
alleviate discomfort and reduce excessive central respiratory drive. Upon recovery from acute
respiratory failure, sedation is reduced to facilitate the withdrawal of ventilatory support.
In some patients, abrupt reduction in sedation provokes severe agitation that causes
catecholamine release resulting in severe hypertension, tachycardia and tachypnea. This
requires increased sedation to bring hemodynamic and respiratory function under control.
Dexmedetomidine is an alpha-2 receptor agonist with both sedative and analgesic properties
that allows for the reduction in the anesthetic and analgesic requirements in the
perioperative setting. In addition to its sedative effects, alpha-2 receptor stimulation in
the central nervous system inhibits sympathetic activity and reduces plasma epinephrine and
norepinephrine levels, thereby lowering both arterial blood pressure and heart rate. Because
alpha-2 receptor stimulation does not cause respiratory depression, dexmedetomidine may
facilitate the transition to unassisted breathing in profoundly agitated patients. The
investigators will prospectively evaluate dexmedetomidine in 30 patients who could not be
extubated because of agitation with hemodynamic instability and tachypnea.
The purpose of this study is to test if a larger prospective randomized controlled pilot
study can show that dexmedetomidine facilitates weaning and extubation in patients who have
failed previous attempts because of agitation and hyperdynamic cardiopulmonary response.