Clinical study of midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in intensive care unit

Purpose： To evaluate midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in ICU. Methods： This randomized, prospective study was conducted in Tianjin Third Central Hospital, China. Using a sealed-envelope method, the patients were randomly divided into 2 groups （40 patients per group）. Each patient of group A received an initial loading dose of midazolam at 0.3 3 mg/kg-h 24 h before extubation, followed by an infusion of dexmedetomidine at a rate of 0.2-1 μg/kg-h until extubation. Each patient of group B received midazolam at a dose of 0.3 3 mg/kg.h until extubation. The dose of sedation was regulated according to PASS sedative scores maintaining in the range of-2-1. All patients were continuously monitored for 60 min after extubation. During the course, heart rate （HR）, mean artery pressure （MAP）, extubation time, adverse reactions, ICU stay, and hospital stay were observed and recorded continuously at the following time points： 24 h before extubation （T1）, 12 h before extubation （T2）, extubation （T3）, 30 rain after extubation （T4）, 60 min after extubation （TS）. Results： Both groups reached the goal of sedation needed for ICU patients. Dexmedetomidine was associated with a significant increase in extubation quality compared with midazolam, reflected in the prevalence of delirium after extubation （20% （8/40） vs 45% （18140））, respectively （p=0.017）. There were no clinically significant decreases in HR and MAP after infusing dexmedetomidine or midazolam. In the group A, HR was not significantly increased after extubation; however, in the group B, HR was significantly increased compared with the preextubation values （p 〈 0.05）. HR was significantly higher in the group B compared with the group A at 30 and 60 min after extubation （both, p 〈 0.05）. Compared with preextubation values, MAP was significantly increased at extubation in the group B （p 〈 0.05） and MAP was significantly higher at T3, T4, T5 in the group B than group A （p 〈 0.05）. There was a significant difference in extubation time （（3.0± 1.5） d vs （4.3 ± 2.2） d, p 〈 0.05）, ICU stay （（5.4 ± 2.1 ） d vs （8.0± 1.4） d, p 〈 0.05）, hospital stay （（10.1 ± 3.0） d vs （15.3 ± 2.6） d, p 〈 0.05） between group A and B. Conclusion： Midazolam sequential with dexmedetomidine can reach the goal of sedation for ICU agitated patients, meanwhile it can maintain the respiratory and circulation parameters and reduce adverse reactions.