title: Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state.
abstract: BACKGROUND
  We evaluated the use of dexmedetomidine to facilitate the weaning of delirious postoperative patients from mechanical ventilation.
  
  
  METHODS
  We included 72 consecutive patients who underwent elective cardiac surgery in this prospective observational study. Each patient had failed at least 1 trial of continuous positive airway pressure (CPAP) and had agitation. Patients were assessed with the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAMICU) 12 to 18 hours after their admission to the ICU. Midazolam and fentanyl were then given to all patients according to the sedation protocol. At 36 hours in the ICU, patients who had agitation and an inability to wean were randomly divided into 2 groups: group M, 34 patients who continued to follow the routine sedative protocol; and group D, 38 patients who were given dexmedetomidine. Arterial blood gas measurements, hemodynamic parameters, and time to extubation were recorded. Statistical analysis was performed with GraphPad InStat (version 2.02 for DOS).
  
  
  RESULTS
  All patients tested positive in the CAM-ICU assessment, and all had a delirium diagnosis. The 38 patients in group D tolerated a spontaneous breathing trial with CPAP and were extubated after a mean (±SD) of 49.619 ± 6.96 hours. The 2 groups had significantly different extubation times (58.389 ± 3.958 hours versus 49.619 ± 6.96 hours). The 2 groups had significantly different RASS scores at 48 and 60 hours and significantly different heart rates and PO2 values at 12 and 24 hours. The 2 groups showed no significant differences with regard to hemodynamic parameters.
  
  
  CONCLUSIONS
  Dexmedetomidine may help to eliminate the emergence of agitation and can be a good treatment choice for the delirium state after cardiac surgery.
authors.affiliation: Anesthesiology and Reanimation Clinic, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey. nihanyapici@gmail.com
authors.forename: Nihan
authors.initials: N
authors.lastname: Yapici
authors.forename: Turkan
authors.initials: T
authors.lastname: Coruh
authors.forename: Tamer
authors.initials: T
authors.lastname: Kehlibar
authors.forename: Fikri
authors.initials: F
authors.lastname: Yapici
authors.forename: Arif
authors.initials: A
authors.lastname: Tarhan
authors.forename: Yesim
authors.initials: Y
authors.lastname: Can
authors.forename: Azmi
authors.initials: A
authors.lastname: Ozler
authors.forename: Zuhal
authors.initials: Z
authors.lastname: Aykac
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000379:methods*; D045422:Continuous Positive Airway Pressure; D003693:Delirium / Q000188:drug therapy*; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006305:Health Status Indicators; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D011594:Psychometrics; D011595:Psychomotor Agitation / Q000188:drug therapy*; D012121:Respiration, Artificial; D015300:Ventilator Weaning / Q000009:adverse effects*
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D014151:Anti-Anxiety Agents; D020927:Dexmedetomidine; D008874:Midazolam; D005283:Fentanyl