Efficacy and Safety of Dexmedetomidine in the Prone Position in Elderly Patients with Pneumonia: A Prospective, Double-Blind, Randomized Controlled Study.

IF 4.6 2区医学 Q1 RESPIRATORY SYSTEM Lung Pub Date : 2024-10-01 Epub Date: 2024-08-07 DOI:10.1007/s00408-024-00735-w

Huixing Zhang, Jingjing Tan, Hui Zhang, Guanghui An, Cheng Li, Lize Xiong

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Abstract

Purpose: We aimed to identify a safe and effective method to assist older adults with pneumonia in tolerating the prone position for a longer duration.

Methods: This was a randomized, controlled, double-blinded study performed at the Shanghai Fourth People's Hospital. Eighty patients with pneumonia aged ≥ 65 years were included. The patients were able to spontaneous breath in the prone position and were administered intravenous dexmedetomidine or an isotonic sodium chloride solution. The cumulative daily durations of prone positioning for all patients in the two groups were recorded. The primary outcome was the percentage of patients who completed ≥ 9 h/day in the prone position. The secondary outcomes included the incidence of complications in the prone position and patient outcomes.

Results: Eighty patients were included (average age: 79.6 ± 8.9 years). The percentage of patients who completed ≥ 9 h/day in the prone position was significantly higher in the dexmedetomidine group than in the placebo group (P = 0.011). The percentage of patients who completed ≥ 12 h/day in the prone position was also significantly greater in the dexmedetomidine group than in the placebo group (P = 0.008). There were no significant differences in other variables between the two groups.

Conclusions: The results of this study demonstrate that intravenous dexmedetomidine injection can significantly prolong the duration of spontaneous breathing in the prone position in elderly pneumonia patients without obvious adverse events. We provide a safe and effective method to help patients with pneumonia, especially those with delirium or cognitive impairment, who cannot tolerate the length of time needed for spontaneous breathing in the prone position to be effective.

Trial registration: The study was registered with the Chinese Clinical Trial Center (registration number: ChiCRT2300067383) on 2023-01-05.

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俯卧位右美托咪定对老年肺炎患者的疗效和安全性：一项前瞻性、双盲、随机对照研究。

目的：我们旨在找出一种安全有效的方法，帮助患有肺炎的老年人更长时间地耐受俯卧位：这是在上海市第四人民医院进行的一项随机、对照、双盲研究。研究纳入了 80 名年龄≥ 65 岁的肺炎患者。患者在俯卧位时能自主呼吸，并静脉注射右美托咪定或等渗氯化钠溶液。记录两组所有患者每天俯卧位的累计时间。主要结果是俯卧位时间≥9小时/天的患者比例。次要结果包括俯卧位并发症发生率和患者预后：共纳入 80 名患者（平均年龄：79.6 ± 8.9 岁）。右美托咪定组俯卧位时间≥9小时/天的患者比例明显高于安慰剂组（P = 0.011）。右美托咪定组患者在俯卧位完成≥ 12 小时/天的百分比也明显高于安慰剂组（P = 0.008）。两组间的其他变量无明显差异：本研究结果表明，静脉注射右美托咪定可明显延长老年肺炎患者俯卧位自主呼吸的时间，且无明显不良反应。我们提供了一种安全有效的方法，帮助那些不能耐受俯卧位自主呼吸所需时间的肺炎患者，尤其是有谵妄或认知障碍的患者：本研究于 2023-01-05 在中国临床试验中心注册（注册号：ChiCRT2300067383）。

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来源期刊

Lung 医学-呼吸系统

CiteScore

9.10

自引率

10.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.