Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Alpha-2 adrenoceptor agonists and sepsis: improved survival? | Quintin Critical Care 2010 14 429 http content 14 4 429 CRITICAL CARE LETTER L_ Alpha-2 adrenoceptor agonists and sepsis improved survival Luc Quintin See related research by Pandharipande etal. http content 14 2 R38 Dr Pandharipande and colleagues should be commended for segregating the effect of dexmedetomidine an alpha-2 adrenoceptor agonist in sepsis 1 . However three questions arise from their study what are the P-values for the data reported in Table 1 Why was there such a discrepancy between the fentanyl dose given to patients on dexmedetomidine and those on lorazepam 1 114 versus 117 pg day P considering the 50 to 80 reduction in the use of opiates commonly observed in the literature when alpha-2 adrenoceptor agonists are administered And how many days did the patients spend on spontaneous for example pressure support versus controlled assisted ventilation In their study survival was better a 70 reduction in risk of dying at 28 days in patients on dexmedetomidine n 31 than in those on lorazepam n 32 . Improved survival was observed earlier in tetanus patients 2 rate of death of 50 versus 11 in control n 10 versus clonidine-treated n 17 patients P this 1998 reference is not cited in the bibliography . In the study of Dr Pandharipande and colleagues baseline characteristics were slightly different Table 1 in 1 temperature heart respiratory rate incidence of vasopr essors dexmedetomidine 32 lorazepam 56 and drotrecogin alpha activated P were higher and systolic pressure lower in the lorazepam group despite similar severity of illness. Could bias explain partially improved survival As concluded by the authors 1 a larger trial should demonstrate improved survival for example upon septic shock 3 . Secondly the dexmedetomidine patients received ten times more fentanyl and had more ventilator-free days. Usually alpha-2 adrenoceptor agonists reduce the need for opiates by 50 to 80 and preserve spontaneous ventilation. So
