DEXMEDETOMIDINE USED IN THE PREVENTION AND TREATMENT OF INTENSIVE CARE UNIT DELIRIUM
Abstract:
A 41-year-old patient, victim of a car accident developed ICU delirium after several days of intensive care stay being treated with dexmedetomidine. Objectives. The purpose of this presentation is to show the importance of using dexmedetomidine for the prevention and treatment of ICU delirium, a frequent ICU-related pathology with narrow therapeutic options. Material and method. The patient was admitted to our ICU, following a car accident, with respiratory failure due to multiple rib fractures, without neurological lesions, no parenchymal organ damage. Results. On the fifth day of ICU, the patient underwent orthopedic surgery under general anesthesia with endotracheal intubation (American Society of Anesthesiology score III. In the immediate postoperative period, the patient was continuously sedated with opioid (fentanyl) and benzodiazepine (midazolam). On the second postoperative day and the eighth day of intensive care stay, the continuous sedation was gradually withdrawn and the patient was extubated. The patient was hemodynamically stable, but he developed restlessness, increased quantity of motor activity and showed a positive confusion assessment method for the ICU score, with poor psychomotor reflexes. Treatment with haloperidol was initiated for two days with no response. On the tenth day of hospitalization, dexmedetomidine was administered (0.2 mcg/kg/h). Treatment with dexmedetomidine was continued for the next 10 days. The patient had a positive treatment-response to dexmedetomidine and was released from ICU on day 27. Conclusion. Dexmedetomidine, an important drug in intensive care but lacking in Romania, would be of great benefit for the patients who develop ICU-delirium. It also decreases the requirements for opioid-analgesics due to its alpha-2 receptor agonist.
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