Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation.
OBJECTIVE
To compare dexmedetomidine (DEX) with standard care (SC, either propofol or midazolam) for long-term sedation in terms of maintaining target sedation and length of intensive care unit (ICU) stay.


METHODS
A pilot, phase III, double-blind multicenter study in randomized medical and surgical patients (n = 85) within the first 72 h of ICU stay with an expected ICU stay of >or=48 h and sedation need for >or=24 h after randomization. Patients were assigned to either DEX (<or=1.4 microg kg(-1) h(-1); n = 41) or SC (n = 44), with daily sedation stops.


RESULTS
Non-inferiority of DEX versus SC was not confirmed. Target Richmond agitation-sedation score (RASS) was reached a median of 64% (DEX) and 63% (SC) of the sedation time (ns). The length of ICU stay was similar in DEX and SC. Patients with RASS target 0-3 (DEX 78%, SC 80%) were at target sedation 74% (DEX) and 64% (SC) of the time (ns), whereas those with RASS target -4 or less reached the target 42% (DEX) and 62% (SC) of the time (P = .006). Post hoc analyses suggested shorter duration of mechanical ventilation for DEX (P = 0.025).


CONCLUSIONS
This pilot study suggests that in long-term sedation, DEX is comparable to SC in maintaining sedation targets of RASS 0 to -3 but not suitable for deep sedation (RASS -4 or less). DEX had no effect on length of ICU stay. Its effects on other relevant clinical outcomes, such as duration of mechanical ventilation, should be tested further.
Ruokonen
Esko
E
Department of Anesthesiology and Intensive Care Medicine, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland.
Parviainen
Ilkka
I
Jakob
Stephan M
SM
Nunes
Silvia
S
Kaukonen
Maija
M
Shepherd
Stephen T
ST
Sarapohja
Toni
T
Bratty
J Raymond
JR
Takala
Jukka
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007362:Intensive Care Units; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D010865:Pilot Projects; D015742:Propofol / Q000008:administration & dosage*; D012121:Respiration, Artificial / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam; D015742:Propofol
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