Effect of dexmedetomidine vs midazolam on the microcirculation of septic patients who are mechanically ventilated

Abstract

Background: Sepsis has been associated with microvascular alterations. Studies have shown dexmedetomidine to have a beneficial effect on the microcirculation in patients with sepsis. In search for better sedation modality, we compared between dexmedetomidine and midazolam in terms of tissue perfusion in patients suffering from sepsis. Methods: A total of 128 patients with sepsis requiring sedation and mechanical ventilation were randomized into 2 groups. Each group comprised 64 patients: Group A (sedated by dexmedetomidine) and Group B (sedated by midazolam); assessment of microcirculation during sedation infusion was performed directly through the peripheral perfusion index (PPI) and indirectly by using global markers of perfusion (ScvO2, P(v-a)Co2). Results: Sixty-four patients were analyzed in each group. Base line characteristics were similar in both groups. We found no significant differences (p > 0.05) between microcirculatory parameters, PPI, Scvo2, and P(v-a)CO2 when comparing between both sedated groups. The 28-day mortality rate was significantly lower (p = 0.042) in dexmedetomidine patients (26.6%) as compared to midazolam patients (43.8%). In addition, there was no difference in ICU stay between the two groups (p = 0.061). Conclusion: Using dexmedetomidine as a sedation option did not provide better peripheral perfusion in patients with sepsis.