Dexmedetomidine can reduce pain when removing a tube from the airway of critically ill patients

Oct 26 2009

A study presented at this year's American Society of Anesthesiologists (ASA) Annual Meeting demonstrated that the use of the sedative Dexmedetomidine was safe and reduced the amount of time for the extubation process, or the process of removing a tube from the airway of critically ill patients. The study participants had failed previous attempts to remove respiratory machine ventilation support.

"Currently, if a patient cannot be successfully extubated, no viable alternative exists aside from performing additional weaning attempts and, in some cases, a tracheotomy," said lead study author Julin F. Tang, M.D., M.S., FCCM, Clinical Professor, Department of Anesthesia and Perioperative Care at San Francisco General Hospital. "This is tremendously hard on the patient. Now, based on the results of this study, Dexmedetomidine may be a viable option for patients who have failed previous attempts to remove the respiratory tubes because it appears to inhibit a stress response in the body that can make it difficult to extubate."

The prospective, randomized controlled study was conducted among 20 critically ill, intensive care patients that were equally randomized to either the control group or the Dexmedetomidine treatment group (10:10). Patients in the control group were weaned from ventilation according to standard hospital protocol. Those in the Dexmedetomidine group received the drug at 0.5 or 0.7mcg/kg/hr. Background sedation and analgesia were gradually decreased in the treatment group and aerosolized lidocaine was initiated prior to weaning. Shortly after Dexmedetomidine infusion, pressure support ventilation (PSV) was initiated and patients were weaned and extubated.

"Although the study size was relatively small, these results suggest that Dexmedetomidine infusion during the weaning process may help control those problems that cause weaning attempts to fail such as agitation, tachypnea, tachycardia and hypertension," said Dr. Tang. "If a patient has these reactions, the medical team must refrain from pulling out the ventilator tube and try again the next day which adds to the patient's hospital costs as well as stress level."

To measure the medication treatment group's condition throughout the trial, researchers looked at the subjects' arterial blood gases at three different points in time, before the medication infusion, during the pressure support ventilation and 30 minutes after the tube was removed. For those patients in the control group, researchers monitored their heart rates, respiratory rates, and Ramsey Sedation Scale scores at three comparable points in time as well: before extubation, the first two hours of extubation attempt and two hours after the patient was extubated.

Following extubation, the amount of time required to take the tube out was distinctly shorter in patients who had received Dexmedetomidine (2.0 ±1.1 vs. 46.0±72.5 hours, P<0.01). Ventilator time was less in these patients (59.2±139.4 vs. 203.9±150.7 hours, P<0.02), and the rate of successful extubation was higher in the treatment group than the control group (8/10 vs. 3/10, P<0.01).

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