الفهرس 
Introduction Aim of the workOnly 14 pages are availabe for public view
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Abstract
Abdominal sepsis is a challenging global health problem as the focus of the disease occurs within a semi-rigid container within which inflammation from the primary disease and subsequent therapies also cause abnormally high intra-abdominal pressure (IAP). Sedation and analgesia in the ICU has gained attention during the last years with immunomodulatory effects of sedation have been demonstrated to influence the clinical course of preexisting inflammatory processes. This stusy aimed to evaluate the effects of using intravenous infusion of dexmedetomidine and propofol as sedation agents compared to midazolam on serum cytokines levels of interleukin 1β (IL1β) and interleukin 6 (IL6) and IAP in mechanically ventilated patients with abdominal sepsis after abdominal surgery. Sixty patients with abdominal sepsis who underwent abdominal surgery for source control, were admitted to ICU postoperatively, mechanically ventilated and sedated with one of three sedative regimens; either midazolam, propofol or dexmedetomidine (20 patients each). The sedative protocol aimed at short term (24 hours infusion duration) and goal directed sedation (Ramsay sedation score of 2 to 4). The midazolam group received a loading dose of midazolam 0.2 mg/kg over 10 minutes followed by a maintenance dose of 0.02-0.2 mg/kg/hour and propofol group received a loading dose of propofol one mg/kg over 15 minutes followed by a maintenance dose of 20-80 µg/kg/min., whereas dexmedetomidine group received a loading dose of dexmedetomidine one µg/kg over 10 minutes followed by a maintenance dose of 0.2 -1.5 µg/kg/hour. The serum levels of IL1β and IL6, IAP, fluid balance, CLI, hemodynamics, blood gas and lung mechanics were all measured and collected at baseline, 24 hours and 48 hours posttreatment. Results demonstrated that dexmedetomidine showed the greatest reduction of IL-1β and IL-6 serum concentrations at 24 hours and 48 hours compared to both midazolam and propofol. Also dexmedetomidine achieved lower IAP measurements and higher APP readings through the first 48 hours posttreatment compared to both midazolam and propofol. Additionally, dexmedetomidine achieved the lowest input and crystalloid intake needed for initial resuscitation of the studied patients through the first 24 hours compared to both midazolam and propofol and also the highest urine output and best fluid balance and renal function during 48 hours posttreatment compared to other treatment lines. Also dexmedetomidine showed the greatest reduction of CLI and vasopressor requirements to achieve the target MAP and better lactate clearance compared to other treatment lines. Finally, the better analgesic profile and the less incidence of delirium made dexmedetomidine patients had less ventilation days, better improvement of SOFA score and less duration of ICU stay. Conclusion: Dexmedetomidine sedation in mechanically ventilated patients with abdominal sepsis improved various clinical outcomes which led to better ICU resource utilization. Dexmedetomidine reduced inflammatory response, IAP, capillary leak, fluid intake and vasopressor requirements with better abdominal perfusion, lactate clearance and renal function. Additionally, the potential better sedation and analgesia state with dexmedetomidine administration might also contribute for improvement of lung mechanics and shorter mechanical ventilation time due to better relaxation of the chest wall.