A Comparative Study between Dexmedetomidine versus Midazolam for Sedation in Patients with Cardiogenic Pulmonary Edema in Intensive Care Unit

Abstract

Providing sedation during non-invasive ventilation management of acute cardiogenic pulmonary edema is associated with a lower rate of non-invasive ventilation failure and the need for endotracheal intubation due to improvement ofpatient tolerance to uncomfortable sessions of non-invasive ventilation. The Ramsay scale, one of the most widely used sedation scales, is an obvious scaleused to assess the effectiveness of the sedatives in our study because of its facile interpretation. Target sedation score of 2 to 3 is desired to avoid over sedation which is associated with airway complications. InAin Shams University Hospitalsintensive care units,one hundred patients who had acute cardiogenic pulmonary edema and hyoxemia during NIV were enrolled in this study. The patients were divided randomly into two groups by the numbered, opaque and sealed envelopes method. They were treated with either midazolam (50 cases) or dexmedetomidine(50 cases). The patients were sedated (Ramsay scale 2-3) by a continuous perfusion of midazolam ordexmedetomidine during the NIV session. The cardiorespiratory and ventilatory parameters, the results of theblood gas analysis, and adverse events were prospectively recorded. The main outcome measure was the percentageof endotracheal intubation during NIV. Secondary endpoints included improvement of cardiorespiratory parameters and occurrence of adverse events. The Results of our study showed that in both groups of patients, the expected sedative scores were obtained. The cardiorespiratory symptoms and signs (oxygenation index, pH value, and respiratory rate) were significantly improved in both groups. In the dexmedetomidine-treated group, the patients had a further decreased percentage of failure of NIV requiring endotracheal intubation (ETI) (p=0.018). Despite the fact that more dexmedetomidine-treated patients developed bradycardia (9 vs. 0, p=0.001), only 2 cases needed intervention, but no patients required interruption of study drug infusion. Conversely, the incidence of respiratory infections and vomiting was lower in the dexmedetomidine-treated patients (p=0.02, p=0.003). According to our study, dexmedetomidine appears to provide several advantages andsafety for NIV sedation in patients with acute cardiogenic pulmonary edema in comparison to the GABA agonist, midazolam.