Effects of Dexmedetomidine vs Midazolam on Microcirculation in Septic Shock Patients
Septic Shock
About this trial
This is an interventional screening trial for Septic Shock
Eligibility Criteria
Inclusion Criteria:
- Patients aged over 18 years
- Septic shock requiring norepinephrine (NE) to maintain a mean arterial pressure (MAP) of at least 65mm Hg despite appropriate volume resuscitation (fluid challenge of 20 mL/kg-40 mL/kg)
- Septic shock criteria were defined according to the new Sepsis-3 definition
Exclusion Criteria:
- pregnancy
- uncontrolled hemorrhage
- terminal heart failure
- significant valvular heart disease
- documented or suspected acute coronary syndrome, and limitations on the use of inotropes: left ventricle outflow obstruction, systolic anterior motion of the mitral valve
- refractory bradycardia (heart rate slower than 60 bpm despite of adequate treatment)
- 2nd and 3rd degree of AV-block ,the onset of septic shock more than 24 h before enrollment ,
- APACHE II > 30 at enrollment
- Severe liver cirrhosis (Child B or C)
- New onset of myocardial infarction within 30 days or heart failure (NYHA 4)
- attending other trial in ICU within one month
- allergic history to dexmedetomidine
Sites / Locations
- Military hospital of tunisRecruiting
- Military Hopital of TunisRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
DEX group
MDZ group
continuous infusion of Dexmedetomidine at 0.4 μg/kg per hour and remifentanyl A microdialysis probe was placed into the femoral quadriceps. An initial set of measurements will be obtained during the sedation with Midazolam and remifentanyl (before randomization). This set of measurements will be considered as baseline. Then samples were collected every 6 hours for 3 days. The changes in the energy-related metabolites lactate, the lactate/pyruvate ratio, glucose and glycerol were analyzed. Concomitantly with dialysate sampling, the effects on global haemodynamics, were assessed. Lactate and L/P clearances were also calculated.
continuous infusion of a Midazolam at 0,1 mg/kg/h and remifentanyl A microdialysis probe was placed into the femoral quadriceps. An initial set of measurements will be obtained during the sedation with Midazolam and remifentanyl (before randomization). This set of measurements will be considered as baseline. Then samples were collected every 6 hours for 3 days. The changes in the energy-related metabolites lactate, the lactate/pyruvate ratio, glucose and glycerol were analyzed. Concomitantly with dialysate sampling, the effects on global haemodynamics, were assessed. Lactate and L/P clearances were also calculated.