Mechanical Ventilation Clinical Trial
Official title:
The Effect of Dexmedetomidine vs Midazolam on Resting Energy Expenditure in Critically Ill Patients: Randomized Controlled Study
The aim of this study is to compare the effect of dexmedetomidine on resting energy expenditure in relation to the midazolam in critically ill patients using indirect calorimetry
Caloric needs in critically-ill patients fluctuate significantly over the course of the
disease which might expose patients to either malnutrition or overfeeding. Malnutrition is
associated with deterioration of lean body mass, poor wound healing, increased risk of
nosocomial infection, and weakened respiratory muscles. On the other hand overfeeding in
medically compromised patients can promote lipogenesis, hyperglycemia, and exacerbation of
respiratory failure. Many factors may affect the resting energy expenditure (REE) through
manipulation of oxygen consumption (VO2).
Sedatives are important contributors to reduction of REE. The postulated mechanism of
sedative-induced reduction of VO2 is inhibition of circulating catecholamine and
pro-inflammatory cytokines.
Dexmedetomidine is a highly selective α2-adrenoceptor agonist. Stimulation of the
α2-adrenoceptor in the central nervous system causes a 60-80% reduction in sympathetic
outflow and endogenous catecholamine levels. It was found that perioperative use of α2
agonists decreased sympathetic activity with subsequent reduction of VO2 and REE. Moreover,
dexmedetomidine, has some anti-inflammatory effect by inhibiting the pro-inflammatory
cytokines which may cause additional reduction of REE in critically ill patient.
Midazolam is another important sedative that is frequently used in critically-ill patient.
Terao et al. found that increasing the depth of sedation using midazolam, decreased oxygen
consumption and REE. However, it remains unclear whether the effect of midazolam on REE is
related to the drug itself or to the depth of sedation.
There is no direct comparison in the literature between dexmedetomidine and midazolam on REE.
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