Effect of midazolam and dexmedetomidine in patients with septic shock during mechanical ventilation

Objective To observe the effect of midazolam and dexmedetomidine in patients with septic shock during mechanical ventilation.

Methods One hundred and thirty-five patients with septic shock treated by mechanical ventilation were randomly divided into midazolam group(n=45), dexmedetomidine group(n=45) and combined sedation group(n=45). On the basis of conventional treatment for septic shock and mechanical ventilation, patients of the midazolam group, dexmedetomidine group and combined sedation group were treated with midazolam, dexmedetomidine, and midazolam combined with dexmedetomidine, respectively. Ramsay Sedation Scale (RSS) scores, vital signs, hospitality-related indicators and prognosis were compared 1 h and 6 h after intervention in the three groups.

Results At 1 h after intervention, the RSS score of the dexmedetomidine group was higher than that of midazolam group and combined sedation group, and the heart rate, respiratory rate and mean arterial pressure (MAP) were lower than those of the midazolam group and the combined sedation group (P < 0.025). There were no significant differences in RSS score, HR, respiratory rate and MAP at 6 h after intervention among the three groups (P > 0.05). The daily wake-up time of the midazolam group was longer than that of the dexmedetomidine group and the combined sedation group, and the analgesic dosage of sufentanil was larger than that of the dexmedetomidine group and the combined sedation group (P < 0.025). There were no significant differences in mechanical ventilation time, ICU stay time and total hospitalization time among three groups (P > 0.05). The incidence of bad memory in the dexmedetomidine group was significantly higher than that in the midazolam group(P < 0.025). There were no significant differences in incidence rates of delirium, hypotension, bradycardia and 28-day mortality among three groups (P > 0.05). Conclusion Midazolam combined with dexmedetomidine is a perfect sedation program for septic shock patients during mechanical ventilation. It could shorten the daily wake-up time and reduce the analgesic dosage of sufentanil, and has less impact on hemodynamics and low incidence of adverse events.