Urinary and renal oxygenation during dexmedetomidine infusion in critically ill adults with mechanistic insights from an ovine model

Mark P Plummer; Yugeesh R Lankadeva; Mark E Finnis; Anatole Harrois; Charlie Harding; Rachel M Peiris; Nobuki Okazaki; Clive N May; Roger G Evans; Christopher M Macisaac; Deborah Barge; Rinaldo Bellomo; Adam M Deane

doi:10.1016/j.jcrc.2021.03.004

Urinary and renal oxygenation during dexmedetomidine infusion in critically ill adults with mechanistic insights from an ovine model

J Crit Care. 2021 Aug:64:74-81. doi: 10.1016/j.jcrc.2021.03.004. Epub 2021 Mar 24.

Authors

Affiliations

¹ Department of Intensive Care, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia. Electronic address: [email protected].
² Department of Critical Care, University of Melbourne, Melbourne, Australia; Preclinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia. Electronic address: [email protected].
³ Department of Critical Care, University of Melbourne, Melbourne, Australia; Department of Intensive Care, Royal Adelaide Hospital, Adelaide, Australia. Electronic address: [email protected].
⁴ Department of Intensive Care, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, Australia; Department of Anesthesia and Surgical Intensive Care, Paris-Saclay University, Bicêtre University Hospital, Le Kremlin Bicêtre, France.
⁵ Department of Intensive Care, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, Australia. Electronic address: [email protected].
⁶ Preclinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia. Electronic address: [email protected].
⁷ Preclinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.
⁸ Department of Critical Care, University of Melbourne, Melbourne, Australia; Preclinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia. Electronic address: [email protected].
⁹ Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia. Electronic address: [email protected].
¹⁰ Department of Intensive Care, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, Australia. Electronic address: [email protected].
¹¹ Department of Intensive Care, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, Australia. Electronic address: [email protected].
¹² Department of Intensive Care, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia. Electronic address: [email protected].
¹³ Department of Intensive Care, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia. Electronic address: [email protected].

PMID: 33794470
DOI: 10.1016/j.jcrc.2021.03.004

Abstract

Purpose: Examine effects of dexmedetomidine on bladder urinary oxygen tension (PuO₂) in critically ill patients and delineate mechanisms in an ovine model.

Materials and methods: In 12 critically ill patients: oxygen-sensing probe inserted in the bladder catheter and dexmedetomidine infusion at a mean (SD) rate of 0.9 ± 0.3 μg/kg/h for 24-h. In 9 sheep: implantation of flow probes around the renal and pulmonary arteries, and oxygen-sensing probes in the renal cortex, renal medulla and bladder catheter; dexmedetomidine infusion at 0.5 μg/kg/h for 4-h and 1.0 μg/kg/h for 4-h then 16 h observation.

Results: In patients, dexmedetomidine decreased bladder PuO₂at 2 (-Δ11 (95% CI 7-16)mmHg), 8 (-Δ 7 (0.1-13)mmHg) and 24 h (-Δ 11 (0.4-21)mmHg). In sheep, dexmedetomidine at 1 μg/kg/h reduced renal medullary oxygenation (-Δ 19 (14-24)mmHg) and bladder PuO₂ (-Δ 12 (7-17)mmHg). There was moderate correlation between renal medullary oxygenation and bladder PuO₂; intraclass correlation co-efficient 0.59 (0.34-0.80). Reductions in renal medullary oxygenation were associated with reductions in blood pressure, cardiac output and renal blood flow (P < 0.01).

Conclusions: Dexmedetomidine decreases PuO₂in critically ill patients and in sheep. In sheep this reflects a decrease in renal medullary oxygenation, associated with reductions in cardiac output, blood pressure and renal blood flow.

Keywords: Critical illness; Dexmedetomidine; Oxygenation; Renal.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Animals
Critical Illness
Dexmedetomidine*
Humans
Kidney
Oxygen
Renal Circulation
Sheep

Substances

Dexmedetomidine
Oxygen