Back to contents
«Messenger of Anesthesiology and Resuscitation» Vol 14, №6, 2017,

DOI : 10.21292/2078-5658-2017-14-6-37-43

Factors defining clinical outcomes in the patients with severe concomitant trauma complicated by delirium

F. F. BERSHАDSKIY , O. N. ULITKINА , YU. V. SKRIPKIN , O. А. GREBENCHIKOV , V. V. LIKHVАNTSEV

  • Moscow Regional Research Clinical Institute named after M. F. Vladimirsky, Moscow, Russia

Search for most effective way of management of non-specific delirium is an important aspect of treatment of severe concomitant trauma.
The objective of the study: to investigate the correlation and impact of sedation method on those injured with delirium during the intensive care of severe concomitant trauma.
Subjects and Methods. The retrospective prospective analysis of two groups of patients with delirium was performed, 30 patients in each group, who received sedation with dexmedetomidine or propofol.
Results. After stopping delirium, the intensity of multiple organ dysfunctions was lower in the group of patients who had sedation with dexmedetomidine. The complex of unfavorable events – death within 1 year and continuous cognitive deficiency was 4 times more frequent in the group of patients after sedation with propofol. Evaluation of the trauma severity was a significant predictor of unfavorable outcomes.
Conclusions. The use of dexmedetomidine for management of delirium resulted in the reduction of multiple organ dysfunctions versus propofol. The severity of trauma was associated with chances to develop a continuous cognitive dysfunction and lethal outcome. Use of dexmedetomidine promoted early rehabilitation in case of cognitive dysfunction.

Key Words: concomitant trauma, delirium, sedation, dexmedetomidine, propofol, cognitive dysfunction, multiple organ dysfunctions

References

  • 1.Bershadskiy F.F., Ulitkina O.N., Skripkin Yu.V. et al. Sedation with dexmedetomidine reducing the duration of delirium treatment in those with concomitant trauma. Аlmanakh Klinicheskoy Meditsiny, 2017, no. 6 (in print).
  • 2.Gelfand B.R., Saltanov А.I. Intensivnaya terapiya. Natsionalnoye rukovodstvo. [Intensive care. National guidelines]. Moscow, GEOTAR-Media Publ., 2011, vol. 2, pp. 984.
  • 3.Kichin V.V., Likhvantsev V.V., Bolshedvorov R.V. et al. Izbrannye voprosy anestezii i intensivnoy terapii tyazheloy sochetannoy travmy. [Selected problems of anesthesia and intensive care of severe concomitant trauma]. Moscow, Granitsa Publ., 2010, pp. 312.
  • 4.Aldecoa C., Bettelli G., Bilotta F. et al. European Society of Anaesthesiology evidence-based and consensus based guideline on postoperative delirium. Eur. J. Anaesthesiol., 2017, vol. 34, no. 4, pp. 192-214.
  • 5.American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J. Am. Coll. Surg., 2015, vol. 220, no. 2, pp. 136-148.
  • 6.Association for Automotive Medicine The Abbreviated Injury Scale 2005. Des Plaines, 2008.
  • 7.Baker S., O'Neill B., Haddon W. et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J. Trauma, 1974, vol. 14, no. 3, pp. 187-196.
  • 8.Bellelli G., Mazzola P., Morandi A. et al. Duration of postoperative delirium is an independent predictor of 6–month mortality in older adults after hip fracture. J. Am. Geriatr. Soc., 2014, vol. 2, no. 7, pp. 1335-1340.
  • 9.Bergeron N., Dubois M., Dumont M., Dial S., Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Int. Care Med., 2001, vol. 27, no. 5, pp. 859-864.
  • 10.Bickel H., Gradinger R., Kochs E. et al. High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dement. Geriatr. Cogn. Disord., 2008, vol. 26, no. 1, pp. 26-31.
  • 11.Cruz D., Antonelli M., Fumagalli R. et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA, 2009, vol. 301, no. 23, pp. 2445-2452.
  • 12.Ely E., Margolin R., Francis J. et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit. Care Med., 2001, vol. 29, no. 7, pp. 1370-1379.
  • 13.Fineberg S., Nandyala S., Marquez-Lara A. et al. Incidence and risk factors for postoperative delirium after lumbar spine surgery. Spine (Phila Pa 1976), 2013, vol. 38, no. 20, pp. 1790-1796.
  • 14.Hoffman W.E., Kochs E., Werner C. et al. Dexmedetomidine improves neurologic outcome from incomplete ischemia in the rat. Reversal by the alpha 2-adrenergic antagonist atipamezole. Anesthesiology, 1991, vol. 75, no. 2, pp. 328-332.
  • 15.Hutton B., Burry L.D., Kanji S. et al. Comparison of sedation strategies for critically ill patients: a protocol for a systematic review incorporating network meta-analyses. Syst. Rev., 2016, vol. 5, no. 1, pp. 157.
  • 16.Kocoglu H., Karaaslan K., Gonca E. et al. Preconditionin effects of dexmedetomidine on myocardial ischemia/reperfusion injury in rats. Curr. Ther. Res. Clin. Exp., 2008, vol. 69, no. 2, pp. 150-158.
  • 17.Le Gall J., Lemeshow S., Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA, 1993, vol. 270, no. 24, pp. 2957-2963.
  • 18.Marcantonio E.R., Juarez G., Goldman L. et al. The relationship of postoperative delirium with psychoactive medications. JAMA, 1994, vol. 272, no. 19, pp. 1518-1522.
  • 19.Mirski M.A., Lewin J.J., Ledroux S. et al. Cognitive improvement during continuous sedation in critically ill, awake and responsive patients: the Acute Neurological ICU Sedation Trial (ANIST). Int. Care Med., 2010, vol. 36, no. 9, pp. 1505-1513.
  • 20.Mock C. World Health Organization Guidelines for essential trauma care. Geneva, World Health Organization, 2004.
  • 21.Nasreddine Z.S., Phillips N.A., Bédirian V. et al. The Montreal Cognitive Assessment (MoCA): A brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc., 2005, vol. 53, no. 4, pp. 695-699.
  • 22.Okada H., Kurita T., Mochizuki T. et al. The cardioprotective effect of dexmedetomidine on global ischaemia in isolated rat hearts. Resuscitation, 2007, vol. 74, no. 3, pp. 538-545.
  • 23.Pandharipande P., Shintani A., Peterson J. et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology, 2006, vol. 104, no. 1, pp. 21-26.
  • 24.Pandharipande P.P., Ely E.W., Arora R. Cet al. The intensive care delirium research agenda: a multinational, interprofessional perspective. Int. Care Med., 2017, vol. 43, no. 4, pp. 1329-1339.
  • 25.Patel S.B., Poston J.T., Pohlman A. et al. Rapidly reversible, sedation-related delirium versus persistent delirium in the intensive care unit. Am. J. Respir. Crit. Care Med., 2014, vol. 189, no. 6, pp. 658-665.
  • 26.Peitz G.J., Balas M.C., Olsen K.M. et al. Top 10 myths regarding sedation and delirium in the ICU. Crit. Care Med., 2013, vol. 41, no. 9, pp. S46– S56.
  • 27.Sessler C., Gosnell M., Grap M. et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am. J. Respir. Crit. Care Med., 2002, vol. 166, no. 10, pp. 1338.
  • 28.Si Y. N., Bao H.G., Xu L. et al. Dexmedetomidine protects against ischemia/reperfusion injury in rat kidney. Eur. Rev. Med. Pharmacol. Sci., 2014, vol. 18, no. 13, pp. 1843-1851.
  • 29.Stigbrand T., Nyberg L., Ullén A. et al. A new specific method for measuring S-100B in serum. Int. J. Biol. Markers, 2000, vol. 15, no. 1, pp. 33-40.
  • 30.Tanabe K., Matsushima-Nishiwaki R., Kozawa O. et al. Dexmedetomidine suppresses interleukin-1β-induced interleukin-6 synthesis in rat glial cells. Int. J. Mol. Med., 2014, vol. 34, no. 4, pp. 1032-1038.
  • 31.Witlox J., Eurelings L., de Jonghe J. et al. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA, 2010, vol. 304, no. 4, pp. 443-451.
  • 32.www.mocatest.org
  • 33.Yang D., Hong J.H. Dexmedetomidine modulates histamine-induced Ca(2+) signaling and pro-inflammatory cytokine expression. Korean J. Physiol. Pharmacol., 2015, vol. 19, no. 5, pp. 413-420.
  • 34.Zhang X., Wang J., Qian W. et al. Dexmedetomidine inhibits inducible nitric oxide synthase in lipopolysaccharide-stimulated microglia by suppression of extracellular signal-regulated kinase. Neurol. Res., 2015, vol. 37, no. 3, pp. 238-245.
  • 35.Zhang X., Wang J., Qian W. et al. Dexmedetomidine inhibits tumor necrosis factor-alpha and interleukin 6 in lipopolysaccharide-stimulated astrocytes by suppression of c-Jun N-terminal kinases. Inflammation, 2014, vol. 37, no. 3, pp. 942-949.

For citation: Bershadskiy F. F., Ulitkina O. N., Skripkin Yu. V., Grebenchikov O. А., Likhvantsev V. V. Factors defining clinical outcomes in the patients with severe concomitant trauma complicated by delirium «Messenger of Anesthesiology and Resuscitation» 2017; 14(6):37-43. DOI : 10.21292/2078-5658-2017-14-6-37-43


For citation: Bershadskiy F. F., Ulitkina O. N., Skripkin Yu. V., Grebenchikov O. А., Likhvantsev V. V. Factors defining clinical outcomes in the patients with severe concomitant trauma complicated by delirium «Messenger of Anesthesiology and Resuscitation» 2017; 14(6):37-43. DOI : 10.21292/2078-5658-2017-14-6-37-43

Для доступа нужна подписка. Войдите в систему для подтверждения ее наличия.