scholarly journals Effectiveness of dexmedetomidine for delirium and its impact on hemodynamics in critically ill patients

2020 ◽  
Vol 24 (6) ◽  
Author(s):  
Shamim Kausar ◽  
Iqra Yasin ◽  
Irfan Ahsan ◽  
Zunairah Rais
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Local Population ◽  
Ethical Review ◽  
Hemodynamic Parameters ◽  
Blood Pressures ◽  
The Impact

Aim/Background: Delirium is common in critically ill patients. For its treatment along with other sedatives, dexmedetomidine has also been prescribed by the clinicians.  However, the outcomes with its use are less well-defined by any study in local population. We aimed to study its effectiveness for delirium and the impact on hemodynamics in critically sick patients of our population. Methodology: It was a cross-sectional, prospective observational study conducted on 212 participants after ethical review committee approval at our hospital. Heart rate, systolic and diastolic blood pressures and Richmond Agitation Sedation Scale (RASS) scores were recorded before starting dexmedetomidine and within one hour of starting the drug. More than 10% decrease in heart rate (HR) or systolic or diastolic blood pressure was considered as an impact on hemodynamic parameters. An achievement of RASS of -2 was considered as effectiveness of drug.  Results: There was a mean drop of HR by 13.78 ± 18.58 beats/min (14.49%) after starting dexmedetomidine. Mean systolic blood pressure drop was 10.99 ± 20.67 mmHg (9.16%), and mean drop in diastolic blood pressure was 4.958 ± 12.53 mmHg after dexmedetomidine use. The mean value of RASS score achieved on dexmedetomidine was -2.  Conclusion: Our study concluded the effectiveness of dexmedetomidine as light sedation for delirium. It significantly impacted on hemodynamic parameters. Its impact on heart rate was more pronounced as compared to systolic and diastolic blood pressures. Key words: Dexmedetomidine; Critical care; Delirium; Hemodynamics Citation: Kausar S, Yasin I, Ahsan I, Rais Z. Effectiveness of dexmedetomidine for delirium and its impact on hemodynamics in critically ill patients. Anaesth. pain intensive care 2020;24(6):--- Received: 14 June 2020, Reviewed: 24 August, 19 October 2020, Accepted: 26 October 2020

The effect of Trendelenburg and modified trendelenburg positions on cardiac output, blood pressure, and oxygenation: a preliminary study

1994 ◽  
Vol 3 (5) ◽  
pp. 382-386 ◽  
Author(s):  
CL Ostrow ◽  
E Hupp ◽  
D Topjian
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Critically Ill ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Critically Ill Patients ◽  
Hemodynamic Parameters ◽  
Trendelenburg Position ◽  
Dependent Variables ◽  
Preliminary Study

BACKGROUND: Although we have insufficient knowledge about the effects of Trendelenburg positions on various hemodynamic parameters, these positions are frequently used to influence cardiac output and blood pressure in critically ill patients. OBJECTIVES: To determine the effect of Trendelenburg and modified Trendelenburg positions on five dependent variables: cardiac output, cardiac index, mean arterial pressure, systemic vascular resistance, and oxygenation in critically ill patients. METHODS: In this preliminary study subjects were 23 cardiac surgery patients (mean age, 55; SD, 8.09) who had a pulmonary artery catheter for cardiac output determination and who were clinically stable, normovolemic and normotensive. Baseline measurements of the dependent variables were taken in the supine position. Patients were then placed in 10 degrees Trendelenburg or 30 degrees modified Trendelenburg position. The dependent variables were measured after 10 minutes in each position. A 2-period, 2-treatment crossover design with a preliminary baseline measurement was used. RESULTS: Five subjects were unable to tolerate Trendelenburg position because of nausea or pain in the sternal incision. In the 18 who were able to tolerate both position changes, no statistically significant changes were found in the five dependent variables. Changes in systemic vascular resistance over time approached statistical significance and warrant further study. CONCLUSIONS: This preliminary study does not provide support for Trendelenburg positions as a means to influence hemodynamic parameters such as cardiac output and blood pressure in normovolemic and normotensive patients.

The Impact of Heart Rate Circadian Rhythm on In-hospital Mortality in Stroke and Critically Ill Patients: Insights from the eICU Collaborative Research Database

2022 ◽  
Author(s):  
Zhengning Yang ◽  
Zhe Li ◽  
Xu He ◽  
Zhen Yao ◽  
XiaoXia Xie ◽  
...  
Keyword(s):  
Heart Rate ◽  
Circadian Rhythm ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Peak Time ◽  
Research Database ◽  
Discriminative Ability ◽  
The Impact ◽  
Apache Iv

Abstract Background: The dysregulation of the heart rate circadian rhythm has been documented to be an independent risk factor in multiple diseases. However, data showing the impact of dysregulated heart rate circadian rhythm in stroke and critically ill patients are scarce.Methods: Stroke and critically ill patients in the ICU between 2014 and 2015 from the recorded eICU Collaborative Research Database were included in the current analyses. The impact of circadian rhythm of heart rate on in-hospital mortality was analyzed. Three variables, Mesor (rhythm-adjusted mean of heart rate), Amplitude (distance from the highest point of circadian rhythm of heart rate to Mesor), and Peak time (time when the circadian rhythm of heart rate reaches the highest point) were used to evaluate the heart rate circadian rhythm. The incremental value of circadian rhythm variables in addition to Acute Physiology and Chronic Health Evaluation (APACHE) IV score to predict in-hospital mortality was also explored.Results: A total of 6,201 eligible patients were included. The in-hospital mortality was 16.2% (1,002/6,201). The circadian rhythm variables of heart rate, Mesor, Amplitude, and Peak time, were identified to be independent risk factors of in-hospital mortality. After adjustments, Mesor per 10 beats per min (bpm) increase was associated with a 1.17-fold (95%CI: 1.11, 1.24, P<0.001) and Amplitude per 5 bpm was associated with a 1.14-fold (95%CI: 1.06, 1.24, P<0.001) increase in the risk of in-hospital mortality, respectively. The risk of in-hospital mortality was lower in patients who had Peak time reached between 18:00-24:00 or 00:00-06:00; whereas the risk was highest in patients who had Peak time reached between 12:00-18:00 (OR: 1.33, 95%CI: 1.05, 1.68, P=0.017). Compared with APACHE IV score only (c-index=0.757), combining APACHE IV score and circadian rhythm variables of heart rate (c-index=0.766) was associated with increased discriminative ability (P=0.003).Conclusion: Circadian rhythm of heart rate is an independent risk factor of the in-hospital mortality in stroke and critically ill patients. Including circadian rhythm variables regarding heart rate might increase the discriminative ability of the risk score to predict the short-term prognosis of patients.

scholarly journals Prokinetic therapy with erythromycin has no significant impact on blood pressure and heart rate in critically ill patients

2007 ◽  
Vol 63 (4) ◽  
pp. 498-500 ◽  
Author(s):  
N. Q. Nguyen ◽  
A. A. Mangoni ◽  
R. J. Fraser ◽  
M. Chapman ◽  
L. Bryant ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prokinetic Therapy

scholarly journals Sodium Valproate versus Continuous Infusion of Haloperidol in Management of Agitated Critically Ill Patients

2019 ◽  
Vol 7 (15) ◽  
pp. 2440-2443
Author(s):  
Ramadan Khalil ◽  
Mohamed Soliman ◽  
Mohamed Omer ◽  
Kamel Abdel Aziz ◽  
Khaled Hussein
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Sedation Score ◽  
Efficacy And Safety ◽  
Qtc Prolongation ◽  
Sedative Drugs

AIM: Describe the efficacy and safety of valproate and haloperidol infusion in controlling agitation in the intensive care unit (ICU). MATERIAL AND METHODS: Prospective study on 100 critically ill patients with agitation in Kasralainy Hospital over the period from May 2016 to June 2017.patients were divided into two groups, each group included 50 patients, 1st group patients received Depakene orally, and 2nd group patients received haloperidol by i.v infusion for 72 h. Richmond agitation sedation score and doses of additional sedative drugs were noted and calculated daily in the first three days. RESULTS: Our study showed that valproate was equal in efficacy in controlling agitation; decreasing the RAAS significantly after 48 h from initiation (2.52 ± 0.61 vs 0.28 ± 0.54 with p < 0.001) for Depakene and (2.6 ± 0.67 vs 0.34 ± 0.48 with p < 0.001) for haloperidol. There was also a decrease in the doses of additional sedative drugs used to control agitation (midazolam & propofol) after 48 h from drug initiation. Both drugs therapy was associated with decrease in heart rate (89 ± 20 vs 86.6 ± 13.6 with p = 0.002 for valproate and 99.8 ± 23.3 vs 91 ± 16.7 with p < 0.001 for haloperidol). They did not affect blood pressure. Haloperidol therapy was associated with significant QTc prolongation. CONCLUSION: Valproate was equal in efficacy as haloperidol infusion in controlling agitation in ICU and decreasing the doses of additional sedative drugs used after 48 h from initiation.

Comparative Evaluation of the Antihypertensive Efficacy of Once-Daily Sustained-Release Isradipine and Lacidipine Using 24-hour Ambulatory Blood-Pressure Monitoring

1995 ◽  
Vol 23 (4) ◽  
pp. 234-243 ◽  
Author(s):  
M Galderisi ◽  
A Petrocelli ◽  
M Garofalo ◽  
A Celentano ◽  
A Alfieri ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Sustained Release ◽  
Diastolic Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Random Order ◽  
Once Daily ◽  
Blood Pressures ◽  
Blood Pressure Range

In this single-blind crossover study the antihypertensive efficacies of two dihydropyridine calcium antagonists, sustained-release isradipine and lacidipine, were compared using clinic and ambulatory blood-pressure measurements. After a 2-week placebo wash-out, 34 patients (19 men, 15 women, mean age 49 years) with mild to moderate hypertension (diastolic blood pressure range 95 – 110 mmHg) were treated with 5 mg sustained-release isradipine for 4 weeks and 4 mg lacidipine for 4 weeks in a random order. Medications were taken once daily at 08.00 h. Clinic and ambulatory blood pressures were recorded at the end of each placebo or treatment period. Two patients stopped isradipine and six lacidipine because of severe adverse effects. Clinic systolic and diastolic blood pressures decreased by an average of 17/14 mmHg with isradipine and 17/13 mmHg with lacidipine, compared with placebo ( P < 0.01 in both cases), without a change in heart rate. Mean ambulatory 24-h and daytime systolic and diastolic blood pressure were significantly reduced by sustained-release isradipine and lacidipine ( P < 0.05 and P < 0.01, respectively). At night systolic blood pressure fell compared with placebo ( P < 0.05 with both drugs) whereas the reduction in diastolic blood pressure was not statistically significant. Mean 24-h heart rate remained unchanged. Blood-pressure variability did not differ significantly between the two drugs or between either drug and the placebo. The antihypertensive effects of sustained-release isradipine and lacidipine were similar, but the tolerability of isradipine appears to be greater since it caused fewer withdrawals.

Resting Cardiovascular Activity and Antisocial Behavior in Essential and Reactive Alcoholic Men

1992 ◽  
Vol 74 (3) ◽  
pp. 847-850
Author(s):  
John T. Braggio ◽  
Vladimir Pishkin ◽  
Oscar A. Parsons ◽  
Steven M. Fishkin ◽  
John R. Tassey
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Behavior Change ◽  
Antisocial Behavior ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Activity ◽  
Blood Pressures

This study showed that 10 men identified as Essential alcoholics had significantly lower resting systolic and diastolic blood pressures and significantly higher scores on Latcham's measure of antisocial behavior than 11 Reactive alcoholics. For all alcoholics the antisocial measure was positively correlated with the total score on the Rudie-McGaughran questionnaire. Also, the antisocial measure was negatively correlated with diastolic blood pressure and heart rate. If lower resting cardiovascular activity were a psychophysiological indicator of more antisocial behavior, change on both variables could be associated with initiation and maintenance of alcoholic drinking by Essential alcoholic men.

Analysis of the impact of a single artificial carbonic acid water bath on hemodynamic parameters in patients with hypertension

Physiotherapy ◽  
2014 ◽  
Vol 22 (4) ◽  
Author(s):  
Rafał Szafraniec ◽  
Wioletta Fryc ◽  
Maciej Kochański
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Stroke Volume ◽  
Carbonic Acid ◽  
Water Bath ◽  
Acid Water ◽  
Hemodynamic Parameters ◽  
Double Product ◽  
The Impact

AbstractAim of the study. The aim of this study was to investigate the effect of a single artificial carbonic acid water bath on hemodynamic parameters in patients with hypertension.Material and methods. Hypertensive patients (n = 33) were measured blood pressure and heart rate before the bath and during the last minute of treatment. Additionally calculated: stroke volume (SV), cardiac output (Q), double product (RPP). The mineral water used in the therapeutic bath was artificially enriched with carbon dioxide (1000 mg/dmResults. HR decreased by 7.6 bpm (p = 0.000001), systolic blood pressure by 9.2 mm Hg (p = 0.000001), diastolic blood pressure by 7.2 mm Hg (p = 0.000001), RPP by 1970.7 (p = 0.000001), SV increased by 3.3 ml (p = 0.00004), and Q did not change and in the both measurements was 3.7 l/min.Conclusions. During the single carbonic acid bath, a decrease in blood pressure, heart rate and double product was observed. Stroke volume has increased, while there was no effect on cardiac output.

Esmolol: effects on isoprenaline- and exercise-induced cardiovascular stimulation in conscious dogs

1990 ◽  
Vol 68 (10) ◽  
pp. 1322-1328 ◽  
Author(s):  
G. Fischer ◽  
J. G. Grohs ◽  
G. Raberger
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Treadmill Exercise ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Concomitant Increase ◽  
Arterial Blood ◽  
Exercise Induced ◽  
The Impact

Esmolol, a recently developed ultra-short acting β-adrenoceptor blocking agent, was evaluated in 12 conscious chronically instrumented dogs with intact autonomic reflexes. The significance of its β1-adrenoceptor selectivity was examined at various cardiovascular activation levels established by either incremental isoprenaline infusion or graded treadmill exercise. The observed parameters were heart rate, systolic and diastolic arterial blood pressure, left ventricular dp/dtmax, and left ventricular end-diastolic pressure. Intravenous infusion of esmolol (25 and 250 μg∙kg−1∙min−1) led to a dose-dependent reduction of the isoprenaline-induced increase in positive dp/dtmax. The concomitant increase in heart rate was suppressed to a lesser extent. Characteristically of a β1-selective agent, esmolol had only a slight effect on the isoprenaline-induced reduction in diastolic blood pressure. The impact of esmolol on exercise-induced hemodynamic activation was much smaller. Exercise-induced increase in positive dp/dtmax was more sensitive to β-adrenoceptor blockade than the concomitant increase in heart rate. Diastolic blood pressure was not influenced significantly. β-Adrenoceptor blockade was virtually reversed within 20 min of discontinuation of esmolol infusion.Key words: esmolol, β1-adrenoceptor selectivity, dogs, treadmill exercise, isoprenaline stimulation.

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