STUDY OF DEXMEDETOMIDINE USE IN INTENSIVE THERAPY OF ALPHOL DELIRIUM IN PATIENTS WITH POLYTRAUMA

Omelchenko-Seliukova A. V., Dubivska S. S., Volkova Y. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The main purpose of this study was to evaluate whether addition of dexmedetomidin during sedation of acute alcohol delirium (AD) in victims with polytrauma is effective and safe. Assess the impact of sedation on the degree and duration of AD, period of hospitalization for ICU, need for mechanical ventilation, benzodiazepines and neuroleptics, prevention of complications to improve the quality of life of patients. To implement the objectives, the study involved 80 patients with moderate polytrauma with alcohol withdrawal, complicated by alcohol delirium, who were treated in 2016-2018 on the basis of the Department of Polytrauma and Anesthesiology for 12 beds for intensive care of patients with concomitant trauma Prof. Meshchaninov Kharkov City Clinical Emergency Hospital. The CAM-ICU (Confusion Assessment Method in Intensive Care Unit) was used to diagnose delirium. Screening was performed daily throughout the patients’ stay in the intensive care unit. If delirium was assessed according to the Intensive Care Delirium Screening Checklist (ICDSC). Patients were divided into two groups: Group 1 (n=40), which was sedated with dexmedetomidine. The initial infusion rate was set at 0.7 μg/kg/h and adjusted in the range of 0.2-1.4 μg/kg/h. Group 2 (n=40), which was sedated with diazepam according to the symptom-trigger protocol. Diazepam was administered every 30 minutes as needed to control active withdrawal symptoms (CIWA-Ar ≥15 or RASS> +2). Antipsychotics (haloperidol, 5 mg bolus) were prescribed in both groups with strong excitement or hallucinations. Groups 1 and 2 did not differ in gender, age, mechanism of injury, location of damaged, severity of injury. During the entire period of hospital stay the following parameters were: time spent in ICU (hours), terms of hospitalization (days), duration of delirium (hours), period of stay on mechanical ventilation (hours), development of complications, average consumed dose of benzodiazepines, need in neuroleptics. According to the results of the study, the total duration of treatment was 12 days [10-19] in group 1 and 13 days [10-21] in group 2, which did not have a significant difference (p=0.672). The duration of hospitalization in ICU was significantly shorter in patients in group 1 and was 55 [52.2-59.8] hours, while patients in group 2 were in ICU 89 [82-96.2] hours (p=0.02042). The use of benzodiazepines and neuroleptics in patients in group 1 was significantly lower. Diazepam consumption for the first 24 hours in group 1 was 20 [20-30] mg, and in group 2 – 40 [40-50] mg. The groups also differed significantly in the total amount of prescribed diazepam during hospitalization in ICU, so in group 1 the total consumption of diazepam was 40 [40-50] mg, in group 2 – 80 [80-90] mg (p=0.033). Neuroleptics were prescribed to 2 patients in group 1 and 16 patients in group 2 (p=0.021273). Patients in group 2 were significantly more likely to need neuroleptics – OR 12.7 95% CI 2.67; 60.06. The daily dose of haloperidol for patients who required it was also significantly higher in group 2 – 20 [15-20] mg, compared with group 1 – 5 [5-7.5] mg (p=0.001761). 26 (65%) patients from group 2 and 8 (20%) patients from group 1 required deeper sedation using mechanical ventilation. That is, patients of group 2 had a significantly higher chance of transfer to mechanical ventilation – OR 7.5 95% CI 2.70; 20.42. In the study of complications, it was found that nosocomial ventilatorassociated pneumonia was diagnosed in 7 (18%) patients of group 2 and 1 (3%) patient of group 1. In the process of correlation analysis, a moderate positive relationship of medium significance was found between the development of nosocomial pneumonia and mechanical ventilation – r-Spearman=0.64 at p=0.014. Thus, dexmedetomidine is an effective and safe drug for sedation of patients with polytrauma with alcohol withdrawal complicated by alcoholic delirium, which reduces the duration of stay in the ICU by 34 hours and significantly reduces the need for diazepam, haloperidol and reduce the number of patients with mechanical ventilation.

alcohol delirium, polytrauma, dexmedetomidine, sedation.

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«Bulletin of problems biology and medicine» Issue 4 (162), 2021 year, 149-154 pages, index UDK 616-001-031.14-089-085-099;616.366-089.86.168

10.29254/2077-4214-2021-4-162-149-154