Dexmedetomidine use in the ICU: Are we there yet?

Ahmed, S and Murugan, R (2013) Dexmedetomidine use in the ICU: Are we there yet? Critical Care, 17 (3). ISSN 1364-8535

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Abstract

Background: Long-term sedation with midazolam or propofol in intensive care units (ICUs) has serious adverse effects. Dexmedetomidine, an alpha-2 agonist available for ICU sedation, may reduce the duration of mechanical ventilation and enhance patient comfort.Methods: Results: Dexmedetomidine/midazolam ratio in time at target sedation was 1.07 (95% confidence interval (CI) 0.97 to 1.18), and dexmedetomidine/propofol ratio in time at target sedation was 1.00 (95% CI 0.92 to 1.08). Median duration of mechanical ventilation appeared shorter with dexmedetomidine (123 hours, interquartile range (IQR) 67 to 337) versus midazolam (164 hours, IQR 92 to 380; P = 0.03) but not with dexmedetomidine (97 hours, IQR 45 to 257) versus propofol (118 hours, IQR 48 to 327; P = 0.24). Patient interaction (measured by using VAS) was improved with dexmedetomidine (estimated score difference versus midazolam 19.7, 95% CI 15.2 to 24.2; P <0.001; and versus propofol 11.2, 95% CI 6.4 to 15.9; P <0.001). Lengths of ICU and hospital stays and mortality rates were similar. Dexmedetomidine versus midazolam patients had more hypotension (51/247 [20.6%] versus 29/250 [11.6%]; P = 0.007) and bradycardia (35/247 [14.2%] versus 13/250 [5.2%]; P <0.001).Conclusions: Among ICU patients receiving prolonged mechanical ventilation, dexmedetomidine was not inferior to midazolam and propofol in maintaining light to moderate sedation. Dexmedetomidine reduced duration of mechanical ventilation compared with midazolam and improved the ability of patients to communicate pain compared with midazolam and propofol. Greater numbers of adverse effects were associated with dexmedetomidine. © 2013 BioMed Central Ltd.

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Details

Item Type:	Article
Status:	Published
Creators/Authors:	Creators Email Pitt Username ORCID Ahmed, S Murugan, R ragimurugan@pitt.edu RAM53 0000-0002-6823-6365
Date:	31 May 2013
Date Type:	Publication
Journal or Publication Title:	Critical Care
Volume:	17
Number:	3
DOI or Unique Handle:	10.1186/cc12707
Schools and Programs:	School of Medicine > Critical Care Medicine
Refereed:	Yes
ISSN:	1364-8535
Date Deposited:	30 Sep 2016 14:28
Last Modified:	04 Feb 2019 22:55
URI:	http://d-scholarship.pitt.edu/id/eprint/29719

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