Clinical study on the safety of dexmedetomidine withdrawal in patients undergoing mechanical ventilation after cardiopulmonary bypass in ICU

Abstract

Objective To compare the safety of dexmedetomidine and midazolam in weaning mechanical ventilation patients after cardiopulmonary bypass (CPB) in ICU. Methods From August 2016 to December 2018, 51 patients admitted to the People's Hospital of Jinhua for mechanical ventilation after ICU CPB cardiac surgery were randomly divided into dexmedetomidine group and midazolam group according to the numerical table method.During mechanical ventilation, dexmedetomidine was used to sedate the study group(26 cases), and midazolam was used in the control group (25 cases). The total time of mechanical ventilation, CPOT score, ICDSC score, incidence of sinus bradycardia during mechanical ventilation were counted, and the anterograde amnesia was observed after extubation.The safety and related factors of drug withdrawal in patients undergoing mechanical ventilation after CPB surgery of two different sedations were compared and evaluated. Results Statistical analysis showed that the CPOT score of the dexmedetomidine group was (1.04±0.45)points, which was significantly lower than that of the midazolam group[(2.24±0.83)points], the difference was statistically significant between the two groups(t=-6.40, P 0.05). The total time of mechanical ventilation was (29.71±17.96)h in the dexmedetomidine group and (26.13±20.02)h in the midazolam group, there was no statistically significant difference between the two groups(t=0.67, P>0.05). During mechanical ventilation sedation, the dexmedetomidine group had more bradycardia, the difference was statistically significant(χ2=11.96, P<0.01). There was no anterograde amnesia in the dexmedetomidine group, but all of the patients in the midazolam group had anterograde amnesia. Conclusion Compared with the midazolam group, the CPOT score was lower in the dexmedetomidine sedation group with the same SAS score of 4(superficial sedation), which in line with the principles of " deep analgesia, shallow sedation". Although bradycardia occurs during the use of drugs, it can recover spontaneously after withdrawal and is safe to use. Key words: Extracorporeal circulation; Cardiac surgical procedures; Respiration, artificial; Bradycardia; Dexmedetomidine; Midazolam