Effect of sedation with midazolam versus dexmedetomidine on gastric emptying assessed by gastric ultrasound in mechanically ventilated patients: A randomized control study

Abstract

Background: Sedation remains an essential component of managing those going through mechanical ventilation in the ICU. This work was aimed at assessing the midazolam effect vs. dexmedetomidine on gastric emptying assessed by gastric ultrasound in mechanically ventilated patients receiving enteral nutrition.Methods: our prospective randomized controlled double-blind study involved 90 individuals whose ages are between twenty-one and sixty years, both genders, expected ICU stay was ≥ 48 h (to permit adequate exposure to the proposed intervention). All participants underwent an even categorization into two groups who were administered sedation with: Midazolam: given as an initial bolus of 0.05 mg/kg loading, then maintenance infusion at 1-2 mg/h, which could be increased by 1-2 mg/h increments till obtaining adequate sedation, or dexmedetomidine: receiving a loading dosage of 0.5 µg/kg over ten min, then maintenance infusion dosage of 0.2 - 0.7 µg/kg/h.Results: The aspirated GRV correlated significantly with the measured antral cross-sectional area (CSA). In Midazolam group, the aspirated GRV increased linearly with the increasing antral CSA (Spearman correlation coefficient: 0.842, p<0.001). In dexmedetomidine group, the aspirated GRV decreased with the decreased antral CSA (Spearman correlation coefficient: 0.573, p<0.001). Regarding CSA and GRV, a significant variation between patients’ measured antral CSA among both groups (p<0.001).Conclusion: Dexmedetomidine is better than midazolam as a sedative drug for those undergoing a mechanical ventilation administering enteral nutrition in ICU because it has a better effect on gastric emptying.