UPOTREBA DEKSMEDETOMIDINA U JEDINICI INTENZIVNOG LEČENJA
Sažetak
Kritična bolest koja zahteva intenzivan tretman predstavlja veoma stresan događaj. Faktori koji prethode prijemu u jedinicu intenzivne nege su životno urožavajuća stanja, trauma ili veoma složena operacija, koji sami po sebi izazivaju snažnu fiziološku reakciju. Sedativi i analgetici su među lekovima koji se najčešće koriste u intenzivnoj nezi. Njihova upotreba ima za cilj povećanje udobnosti, smanjenje odgovora na stres i olakšavanje dijagnostičkih i terapijskih procedura. Potvrđeno je da su bol, prekomerna sedacija i delirijum značajni uzročnici stresa kod bolesnika u intenzivnoj nezi i povezani sa povećanim morbiditetom i mortalitetom. Termin „trijada intenzivne nege“ opisuje blisku povezanost bola, uznemirenosti i delirijuma, kao i pristup njihovom lečenju. U smernicama iz 2013. i 2018. godine za analgeziju i sedaciju kod kritično bolesnih preporučena je upotreba midazolama, samo za kratkotrajnu sedaciju, lorazepama, za dugotrajnu sedaciju, a propofola za bolesnike kod kojih je planirano povremeno buđenje. U novim verzijama smernica data je prednost sedativima koji nisu benzodiazepin, kao što je deksmedetomidin. Deksmedetomidin proizvodi jedinstveni obrazac sedacije, koji se značajno razlikuje u poređenju sa svim drugim sedativnim lekovima. Bolesnici sedirani ovim lekom lako uspostavljaju kontakt, reaguju na verbalnu stimulaciju, komuniciraju i sarađuju sa osobljem intenzivne nege, a nakon uspostavljanja kontakta, postižu dobre rezultate na testovima pažnje.
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