Use of Dexmedetomidine to Facilitate Extubation in Surgical ICU Patients Who Failed Previous Weaning Attempts
Stopped early · Not applicable
Conditions studied: Intubation; Difficult, Respiration Disorders
In brief
Mechanical ventilation commonly is associated with patient agitation requiring sedation to alleviate discomfort and reduce excessive central respiratory drive. Upon recovery from acute respiratory failure, sedation is reduced to facilitate the withdrawal of ventilatory support. In some patients, abrupt reduction in sedation provokes severe agitation that causes catecholamine release resulting in severe hypertension, tachycardia and tachypnea. This requires increased sedation to bring hemodynamic and respiratory function under control. Dexmedetomidine is an alpha-2 receptor agonist with both sedative and analgesic properties that allows for the reduction in the anesthetic and analgesic requirements in the perioperative setting. In addition to its sedative effects, alpha-2 receptor stimulation in the central nervous system inhibits sympathetic activity and reduces plasma epinephrine and norepinephrine levels, thereby lowering both arterial blood pressure and heart rate. Because alpha-2 receptor stimulation does not cause respiratory depression, dexmedetomidine may facilitate the transition to unassisted breathing in profoundly agitated patients. The investigators will prospectively evaluate dexmedetomidine in 30 patients who could not be extubated because of agitation with hemodynamic instability and tachypnea. The purpose of this study is to test if a larger prospective randomized controlled pilot study can show that dexmedetomidine facilitates weaning and extubation in patients who have failed previous attempts because of agitation and hyperdynamic cardiopulmonary response.
Key facts
- Study ID
- NCT00464490
- Run by
- University of California, San Francisco
- People needed
- 42
- Starts
- 2007-11-01
- Expected to finish
- 2012-12-01
- Last updated by the study team
- 2014-10-31
Who can join
Age: 18 and older, up to 69. Sex: any. Healthy volunteers: not accepted.
You may qualify if…
- Age less than 70 years old
- Normothermia (36.5 degrees centigrade)
- Normal sinus rhythm
- Hemodynamically stable (systolic blood pressure [SBP] > 110 mmHg)
- Ejection fraction (EF) > 40%/absence of congestive heart failure (CHF)
- Cardiac index > 2.5 L/min/m2
- Minimal inotropic support (< 3 mcg/kg/min dobutamine)
- Adequate coagulation profile
- Adequate urine output (> 100 ml/hr)
- Primary service and critical care physician agreement
You may not qualify if…
- Prior use of clonidine or alpha-antagonists
- Prior history of intravenous drug abuse (IVDA) or alcohol abuse (ETOH)
- Evidence of heart block
- Difficulty with oxygenation/ventilation
- Renal or hepatic insufficiency
- Pregnant (positive urine or serum pregnancy test upon admission)
- Patient received dexmedetomidine > 24 hours
Where it is running
- University of California, San Francisco — San Francisco, California, United States
Full record on ClinicalTrials.gov
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