PURPOSE:Non-invasive mechanical ventilation (NIMV) has been used as treatment of acute respiratory failure due to cardiac and pulmonary conditions. Failure with NIMV is reported about 30%. Dexmedetomidine (DMT) has been used for the weaning of invasive mechanical ventilation (IMV) and to adapt patients to NIMV in different conditions. In pulmonary hypertension (PH) and acute respiratory failure (ARF) DMT has not been described.We designed this pilot study in order to know if the DMT could be used in this population.
METHODS:Design: Pilot prospective. We studied patients with different causes of pulmonary hypertension. Demographics, blood gas test (BGT) echocardiographics (ECHO) and hemodynamics (HEMO) data were obtained.Statistical analysis: Data are expressed as mean±standard deviation (M±SD). Differences between before-after drug were evaluated with paired-samples t test. P<0.05 was accepted as statistically significative.
RESULTS:31 acute and chronic PH patients were studied, 23/8 female/male. Age 59±17 yo. Systolic pulmonary arterial pressure (PAP-s) 74.94±23.6 mmHg. BGT and HEMO before-after administration of DMT data are shown in Table I. Drug doses 0.63±0.14 mg/ml/kg, time-response to drug 20.13±3.70 min, time with NIMV 19.13±16.70 hrs. 27 (87%) patients had good response, 4 (12.9%) required IMV, 1 (3.23%) patient died not-related to experimental drug.
CONCLUSION:Dexmedetomidine permitted to adapt PH patients to NIMV. Deterioration of the mean systemic arterial pressure (SAP-m)was seen.
CLINICAL IMPLICATIONS:Although the effect of dexmedetomidine was good, the effect on SAP-m may limit its use. We don't know if this effect was due to the drug or NIMV and requires further investigation.
DISCLOSURE:Hector Peña-Carillo, No Financial Disclosure Information; No Product/Research Disclosure Information