Uso de dexmedetomidina en unidades de cuidados intensivos cardiológicos: estudio de eficacia y seguridad

La dexmedetomidina es un fármaco agonista de los receptores alfa-2 adrenérgicos cuyas atractivas características farmacocinéticas y farmacodinámicas han potenciado su uso como agente sedante y analgésico. Su capacidad para inducir sedación consciente, de inicio y fin rápido, y sus efectos ansiolíticos, hipnóticos, analgésicos y órgano-protectores lo acercan al fármaco sedante ideal. Su uso en unidades de cuidados intensivos (UCI) ha demostrado reducir el uso de otros sedantes, tiempo bajo ventilación mecánica y duración de la estancia hospitalaria, además de prevenir y tratar de forma eficaz el delirium. El desarrollo de las unidades de cuidados intensivos cardiológicos (UCIC) ha generalizado el uso de fármacos sedantes en estas unidades, habituales en el enfermo crítico. El uso de dexmedetomidina supone un reto en las UCICs por la vulnerabilidad del paciente cardiológico agudo a sus principales efectos adversos, bradicardia e hipotensión, y la escasa experiencia y evidencia de uso en estos pacintes. La hipótesis principal de este trabajo es que el uso de dexmedetomidina es factible en el paciente cardiológico agudo, aportando múltiples beneficios al igual que aquellos demostrados en pacientes ingresados en UCIs. A pesar de la potencial vulnerabilidad a sus efectos adversos se ha descrito un buen perfil de seguridad en pacientes post-operados cardiacos. Esta tesis tiene como objetivo principal recabar información acerca del patrón de uso real de la dexmedetomidina en UCICs, así como distintos parámetros clínicos que permitan analizar la seguridad y eficacia del fármaco en estos pacientes. Como objetivos secundarios estarían conocer el perfil clínico de los pacientes candidatos a esta medicación en UCICs, las principales indicaciones del fármaco en estas unidades y el efecto de la dexmedetomidina en la incidencia del delirium..

Apical ventricular hypertrophy in the transplanted heart: a 20-year single-center experience

Sin financiación4.753 JCR (2020) Q2, 45/142 Cardiac & Cardiovascular Systems0.455 SJR (2020) Q3, 202/349 Cardiology and Cardiovascular MedicineNo data IDR 2020UE

Dexmedetomidine in Medical Cardiac Intensive Care Units. Data From a Multicenter Prospective Registry

Background: Dexmedetomidine induces cooperative and arousable sedation. Our aim was to analyze dexmedetomidine use in medical cardiac intensive care units (CICU). Methods: Multicenter prospective registry of patients treated with dexmedetomidine in CICU. Consecutive inclusion during a 12-month period. Results: A total of 410 patients were included, mean age was 67.4 ± 13.9 years, and 94 (22.9%) were women. Before using dexmedetomidine, 247 patients (60.2%) had delirium, 48 developed delirium after dexmedetomidine use. In 178 (43.4%) dexmedetomidine was used during weaning from mechanical ventilation, with a reintubation rate of 10.1%, early reintubation rate (<24 h) 1.7%. Seventy-seven patients (18.8%) died during admission. Dexmedetomidine mean dose infusion was 0.51 ± 0.25 μ/kg/h, during a median of 34 h (interquartile range 12-78 h). Three hundred forty-eight patients received adjuvant sedatives (84.9%). Sixty-eight patients (16.6%) had adverse effects. The most frequent adverse effects were hypotension with systolic blood pressure <80 mmHg (44 patients - 10.7%), bradycardia <40 beats per minute (15 patients - 3.7%), and both bradycardia and hypotension (4 patients - 1.0%). Patients with adverse effects received more frequently inotropes (53 [81.6%] vs. 212 [65.4%], p = 0.02) and fewer adjuvant sedatives (49 [75.4%] vs. 282 [87.0%], p = 0.01). The independent predictors of adverse effects were inotropes use (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.30-5.74, p = 0.008) and lack of adjuvant sedatives (OR 3.03, 95% CI 1.49-6.26, p = 0.002). Conclusion: Dexmedetomidine safety for medical CICU patients seems to be similar to that for general intensive care unit patients. Inotropes and lack of adjuvant sedatives were associated with adverse effects.Sin financiación4.164 JCR (2020) Q2, 56/142 Cardiac & Cardiovascular Systems1.406 SJR (2020) Q1, 62/349 Cardiology and Cardiovascular MedicineNo data IDR 2020UE

Infective endocarditis in patients with cardiac implantable electronic devices: a nationwide study

Aims Patients with infective endocarditis (IE) frequently have cardiac implantable electronic devices (CIEDs). Here, we aim to define the clinical profile and prognostic factors of IE in these patients. Methods and results Infective endocarditis cases were prospectively identified in the Spanish National Endocarditis Registry. From 3996 IE, 708 (17.7%) had a CIED and 424 CIED-related IE (lead vegetation). Patients with a CIED were older (68 ± 11 vs. 73 ± 8 years); had more comorbidities {pulmonary disease [176 (24.8%) vs. 545 (16.7%)], renal disease [239 (33.8%) vs. 740 (22.7%)], diabetes [248 (35.0%) vs. 867 (26.6%)], and heart failure [348 (49.2%) vs. 978 (29.9%)]}; and fewer complications {intracardiac destruction [106 (15%) vs. 1077 (33.1%)], heart failure [215 (30.3%) vs. 1340 (41.1%)], embolism [107 (15.1%) vs. 714 (21.9%)], and neurological involvement [77 (10.8%) vs. 702 (21.5%)]} (all P-values <0.001) in comparison to subjects without a CIED. In-hospital mortality was similar in patients with and without CIED [171 (24.2%) vs. 881 (27.0%), P = 0.82]. In subjects with a CIED, CIED-related IE was independently associated with in-hospital survival: odds ratio (OR) 0.4 [95% confidence interval (CI) 0.3–0.7, P = 0.001]. Surgery was independently associated with in-hospital survival in CIED-related IE: OR 0.4 (95% CI 0.2–0.7, P = 0.004); but not in subjects with valve IE and no CIED lead involvement: OR 0.9 (95% CI 0.5–1.7, P = 0.77). Conclusion Over a sixth of IE patients have a CIED. This group of patients is older, with more comorbidities and fewer IE-related complications in comparison to subjects without a CIED. In-hospital mortality was similar in patients with and without a CIED.Sin financiación5.214 JCR (2020) Q2, 40/142 Cardiac & Cardiovascular Systems2.119 SJR (2020) Q1, 36/349 Cardiology and Cardiovascular MedicineNo data IDR 2020UE

Infective endocarditis in patients with cardiac implantable electronic devices: a nationwide study

AIMS Patients with infective endocarditis (IE) frequently have cardiac implantable electronic devices (CIEDs). Here, we aim to define the clinical profile and prognostic factors of IE in these patients. METHODS AND RESULTS Infective endocarditis cases were prospectively identified in the Spanish National Endocarditis Registry. From 3996 IE, 708 (17.7%) had a CIED and 424 CIED-related IE (lead vegetation). Patients with a CIED were older (68 ± 11 vs. 73 ± 8 years); had more comorbidities {pulmonary disease [176 (24.8%) vs. 545 (16.7%)], renal disease [239 (33.8%) vs. 740 (22.7%)], diabetes [248 (35.0%) vs. 867 (26.6%)], and heart failure [348 (49.2%) vs. 978 (29.9%)]}; and fewer complications {intracardiac destruction [106 (15%) vs. 1077 (33.1%)], heart failure [215 (30.3%) vs. 1340 (41.1%)], embolism [107 (15.1%) vs. 714 (21.9%)], and neurological involvement [77 (10.8%) vs. 702 (21.5%)]} (all P-values <0.001) in comparison to subjects without a CIED. In-hospital mortality was similar in patients with and without CIED [171 (24.2%) vs. 881 (27.0%), P = 0.82]. In subjects with a CIED, CIED-related IE was independently associated with in-hospital survival: odds ratio (OR) 0.4 [95% confidence interval (CI) 0.3-0.7, P = 0.001]. Surgery was independently associated with in-hospital survival in CIED-related IE: OR 0.4 (95% CI 0.2-0.7, P = 0.004); but not in subjects with valve IE and no CIED lead involvement: OR 0.9 (95% CI 0.5-1.7, P = 0.77). CONCLUSION Over a sixth of IE patients have a CIED. This group of patients is older, with more comorbidities and fewer IE-related complications in comparison to subjects without a CIED. In-hospital mortality was similar in patients with and without a CIED