GKD Anest Yoð Bak Dern Derg. 2021; 27(2): 166-170 | DOI: 10.5222/GKDAD.2021.69370

Age-related Hemodynamic Effects of Long-term Use of Dexmedetomidine During NIV.

Lerzan Dogan¹, Duygu Emine Guduk¹, Ilkay Kisa Ozdemir¹, Tugce Sarikaya^2
1Acibadem Altunizade Hospital, Intensive Care, Istanbul
²Acibadem Mehmet Ali Aydinlar University, Department Of Anaesthesiology And Reanimation, Istanbul

Objective: Sedation in the intensive care unit plays a key role in patient management as it helps suppress agitation, increases tolerance to stress, and facilitates medical interventions, such as noninvasive ventilation (NIV) Our purpose was to determine the long-term hemodynamic effects of dexmedetomidine in elderly patients with acute respiratory failure who require NIV.
Methods: We recorded the data concerning age, comorbidities, doses of dexmedetomidine, hemodynamic parameters, use of vasopressors and length of ICU stay, from the hospital electronic medical recor system Due to the possibility of causing hemodynamic instability in ICU, patients with reduced ventricular contractility, hypothermia, septic shock, endocrine pathologies and neurosurgery cases, were excluded from the study.
Results: The patients were evaluated in four age groups: Group I: 18-39 years; Group II, 40-64 years; Group III, 65-80 years, and Group IV, aged >80 years The patients in group IV were found to be at a higher risk for a decrease in MAP following onset of dexmedetomidine treatment (p=0.005*). Notably, most of the vasoactive agents were used in patients over 85 years old (54.2%, p=0.005). With increasing age hypotension and vasopressor needs were found to exhibit a corresponding augmentation.
Conclusion: Dexmedetomidine meets requirements for sedation during NIV in the ICU. Even without loading dose the drug can induce hemodynamic instability, therefore close monitoring is necessary. In elderly, dexmedetomidine should be started at the lowest possible dose and slowly titrated according to the patient’s response.

Keywords: Dexmedetomidine, Elderly patient, Non-invasive ventilation, Sedation

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NIV sýrasýnda Uzun Süreli Deksmedetomidin Kullanýmýnýn Yaþa Baðlý Hemodinamik Etkileri

Lerzan Dogan¹, Duygu Emine Guduk¹, Ilkay Kisa Ozdemir¹, Tugce Sarikaya^2
1Acibadem Altunizade Hastanesi, Yoðun Bakým, Ýstanbul
²Acibadem Mehmet Ali Aydinlar Üniversitesi, Anesteziyoloji Ve Reanimasyon Bölümü, Ýstanbul

Amaç: Yoðun bakým ünitesinde sedasyon ajitasyon ve strese yanýtýný baskýlamak ve non-invaziv ventilasyon gibi týbbi müdahaleleri kolaylaþtýrmak açýsýndan önemli rol oynar. Bu çalýþmada amaç, yoðun bakýmda akut solunum yetmezliði nedeniyle non-invaziv ventilasyon desteði alan hastalarda uzun süreli deksmedetomidin kullanýmýnýn yaþa baðlý hemodinamik etkilerini incelemek.
Yöntem: Hastane elektronik týbbi kayýtlarýndan yaþ, ek hastalýk, deksmedetomidin dozlarý, hemodinamik parametreler, vazopressör kullanýmý ve yoðun bakým kalýþ süresi gibi veriler kaydedildi. Azalmýþ ventriküler kontraktilite, hipotermi, septik þok, endokrin patolojiler ve beyin cerrahisi hastalarý doðrudan hemodinamik instabiliteye neden olabileceklerinden çalýþma dýþý býrakýldý.
Bulgular: Hastalar dört grup halinde deðerlendirildi: 18-39 (Grup I), 40-64 (Grup II), 65-80 (Grup III) ve >80 yaþ (Grup IV). Seksen beþ yaþ ve üzerindeki ileri yaþlý hastalarýn deksmedetomidin baþlangýcýný takiben ortalama arter basýncýnda diðer gruplardan daha fazla azalma saptanmýþtýr (p=0.005*). Vazoaktif ajan kullanýmý da ayný þekilde 85 yaþ üstü olan hastalarda daha fazla görülmüþtür (% 54,2, p=0,005). Yaþ arttýkça, hipotansiyon ve vazopresör ihtiyaçlarýnýn da arttýðý saptanmýþtýr.
Sonuç: Deksmedetomidin yoðun bakýmda NIV sýrasýnda sedasyon gereksinimlerini karþýlar. Yükleme dozu olmasa dahi hemodinamik dengesizlik gözlemlenebilir, bu nedenle yakýn izlem gereklidir. Yaþlýlarda deksmedetomidin mümkün olan en düþük dozda baþlatýlmalý ve cevaba göre titre edilmelidir.

Anahtar Kelimeler: Deksmedetomidin, Yaþlý hasta, Non-invazif ventilasyon, Sedasyon

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