Dexmédétomidine et clonidine : revue de leurs propriétés pharmacodynamiques en vue de définir la place des agonistes alpha-2 adrénergiques dans la sédation en réanimation

Pichot, Cyrille; Longrois, Dan; Ghignone, M.; Quintin, Luc

doi:10.1016/j.annfar.2012.07.018

Cited by 21 publications

(16 citation statements)

References 198 publications

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“…Alpha-2 agonists generate no emergence delirium and prolonged elimination, and alter the hypothalamic set-point [124] thus causing slight hypothermia (≈ 35,5°C) [108,109,125] and lower VO 2 during weaning [82]. Thus, "cooperative" sedation [13,126], or little/no sedation [15,127] in non-combative patients, are to be considered [27,30,71]. Then, new ventilator modes (PS, APRV, etc.)…”

Section: Sedationmentioning

confidence: 99%

Early severe acute respiratory distress syndrome: What’s going on? Part II: controlled vs. spontaneous ventilation?

Petitjeans

Pichot

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

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The second part of this overview on early severe ARDS delineates the pros and cons of the following: a) controlled mechanical ventilation (CMV: lowered oxygen consumption and perfect patient-to-ventilator synchrony), to be used during acute cardio-ventilatory distress in order to "buy time" and correct circulatory insufficiency and metabolic defects (acidosis, etc.); b) spontaneous ventilation (SV: improved venous return, lowered intrathoracic pressure, absence of muscle atrophy). Given a stabilized early severe ARDS, as soon as the overall clinical situation improves, spontaneous ventilation will be used with the following stringent conditionalities: upfront circulatory optimization, upright positioning, lowered VO 2 , lowered acidotic and hypercapnic drives, sedation without ventilatory depression and without lowered muscular tone, as well as high PEEP (titrated on transpulmonary pressure, or as a second best: "trial"-PEEP) with spontaneous ventilation + pressure support (or newer modes of ventilation). As these propositions require evidence-based demonstration, the reader is reminded that the accepted practice remains, in 2016, controlled mechanical ventilation, muscle relaxation and prone position. Anestezjologia Intensywna Terapia 2016, tom 48, nr 5, 354-366Key words: acute respiratory distress syndrome, ARDS, severe ARDS; acute hypoxic non-hypercapnic respiratory failure; driving pressure; tidal volume, Vt, low tidal volume, ultra-low tidal volume; positive end-expiratory pressure, PEEP; transpulmonary pressure; controlled mechanical ventilation; spontaneous ventilation; spontaneous breathing; pressure support, airway pressure release ventilation; sedation, cooperative sedation; alpha-2 adrenergic agonist, clonidine, dexmedetomidineThe previous chapter overviewed, for residents rotating through the critical care unit (CCU), basic pathophysiology required to analyze early severe acute respiratory distress syndrome (ARDS). An emphasis was placed on spontaneous ventilation both in the setting of the healthy volunteer and of severe ARDS. This chapter will address the pros and cons of controlled mechanical ventilation, with the help of muscle relaxation, as opposed to the putative advantages of spontaneous ventilation. So far, spontaneous ventilation has not achieved evidence-based demonstration: thus, as in part I, conjectures are within [….], following [1]. i. MUSCLE RELAXATiON VERSUS SPONTANEOUS VENTiLATiON?When muscle relaxation is considered, the overall picture appears to be simplified with 48 h of muscle relaxation [2]. A sober interpretation may be considered. a. Muscle relaxationIn severe ARDS (P/F < 120), muscle relaxation [2] lowered the mortality (45 to 31%; difference of −32%; P = 0.04), multiple organ failure (MOF), and barotrauma and led to more ventilator-free days and identical CCU-acquired paresis. Muscle relaxation was hypothesized to minimize excessive transpulmonary pressure, patient-to-ventilator asynchrony [2], ventilator-induced lung injury (VILI), atelectrauma, overdistension,...

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Section: Sedationmentioning

confidence: 99%

Early severe acute respiratory distress syndrome: What’s going on? Part II: controlled vs. spontaneous ventilation?

Petitjeans

Pichot

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

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“…[7]. Compte tenu de l'effet sympatholytique puissant de la dexmedetomidine, les doses de propofol proposées par Shehabi [67] sont de très petites doses.…”

Section: Dose-réponseunclassified

“…La plupart des auteurs utilise une dose maximale ≤ 1,5 g/kg/h (effet plafond [20]). À ce dosage, une inefficacité suggère l'adjonction de neuroleptiques [7,67] 4) Durée minimale du palier d'augmentation de vitesse d'administration > 30 min. Les paliers minima de diminution de vitesse d'administration peuvent être plus courts 5) FC < 50 bpmin : arrêt de la dexmédétomidine ; information du médecin 6) PAS < 100 mmHg ou PAM < 50 mmHg, information le médecin Traitement : lever de jambe passif, position tête basse, expansion volémique.…”

Section: Indications De La Dexmédétomidineunclassified

“…Les indications potentielles et avantages de la dexmédé-tomidine, suggérés par l'analyse de la littérature [7] …”

Section: Indications De La Dexmédétomidineunclassified

“…Avec ce cahier des charges, la dexmédétomidine peutelle être un agent de sédation de première intention [6,7] ? Plusieurs revues récentes [8,9] qui ont comparé la dexmédé-tomidine aux agents sédatifs conventionnels (midazolam et propofol) permettent éventuellement de répondre à cette question.…”

Section: Introductionunclassified

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La dexmédétomidine : raisonnement clinique en vue d’une utilisation pour la sédation en réanimation chez l’adulte

Longrois

Quintin

2015

Le Praticien en Anesthésie Réanimation

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Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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BackgroundAcute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.ObjectivesTo determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles.MethodA systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system.ResultsWe formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65–70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely.ConclusionThe results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4832-y) contains supplementary material, which is available to authorized users.

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Dexmédétomidine et clonidine : revue de leurs propriétés pharmacodynamiques en vue de définir la place des agonistes alpha-2 adrénergiques dans la sédation en réanimation

Cited by 21 publications

References 198 publications

Early severe acute respiratory distress syndrome: What’s going on? Part II: controlled vs. spontaneous ventilation?

Early severe acute respiratory distress syndrome: What’s going on? Part II: controlled vs. spontaneous ventilation?

La dexmédétomidine : raisonnement clinique en vue d’une utilisation pour la sédation en réanimation chez l’adulte

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

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