title: Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study.
abstract: BACKGROUND
  Dexmedetomidine can be used for sedation of mechanically ventilated patients and has minor respiratory effects. The aim of this study was to compare the incidence of patient-ventilator dyssynchronies during sedation with dexmedetomidine or propofol.
  
  
  METHODS
  We conducted a multicentre, prospective, open-label, randomised clinical trial, comparing dexmedetomidine with standard propofol sedation at three intensive care units of university hospitals in Italy. Twenty difficult-to-wean patients for whom the first weaning trial had failed and who were on pressure support ventilation were randomised to receive sedation with either dexmedetomidine or propofol at a similar level of sedation (Richmond Agitation-Sedation Scale [RASS] score +1 to -2). The asynchrony index (AI) was calculated using tracings of airflow, airway pressure and electrical activity of the diaphragm sampled at 0, 0.5, 1, 2, 6, 12, 18 and 24 h.
  
  
  RESULTS
  The mean AI was lower with dexmedetomidine than with propofol from 2 h onwards, although the two groups significantly differed only at 12 h (2.68 % vs 9.10 %, p < 0.05). No further difference was observed at 18 and 24 h.
  
  
  CONCLUSIONS
  When sedation with propofol and dexmedetomidine was compared at similar RASS scores of patients in whom first weaning trial had failed, the AI was lower with dexmedetomidine than with propofol, and this difference was statistically significant at 12 h. These results suggest that sedation with dexmedetomidine may offer some advantages in terms of patient-ventilator synchrony.
authors.affiliation: Department of Intensive Care and Anaesthesia, Catholic University of Rome, Policlinico A. Gemelli, Largo F. Vito 1, Rome, 00168, Italy. giorgio.conti@unicatt.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
authors.forename: Vito Marco
authors.initials: VM
authors.lastname: Ranieri
authors.affiliation: Department of Intensive Care and Anaesthesia, Catholic University of Rome, Policlinico A. Gemelli, Largo F. Vito 1, Rome, 00168, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Costa
authors.affiliation: Orion Pharma R&D, Nottingham, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Garratt
authors.affiliation: Orion Pharma R&D, Nottingham, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wighton
authors.affiliation: Department of Intensive Care and Anaesthesia, Catholic University of Rome, Policlinico A. Gemelli, Largo F. Vito 1, Rome, 00168, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Spinazzola
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, S. Giovanni Battista Molinette Hospital, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Urbino
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Mascia
authors.affiliation: Department of Intensive Care and Anaesthesia, Catholic University of Rome, Policlinico A. Gemelli, Largo F. Vito 1, Rome, 00168, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Ferrone
authors.affiliation: Orion Pharma R&D, Kuopio, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Pohjanjousi
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, S. Giovanni Battista Molinette Hospital, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ferreyra
authors.affiliation: Department of Intensive Care and Anaesthesia, Catholic University of Rome, Policlinico A. Gemelli, Largo F. Vito 1, Rome, 00168, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D020927:Dexmedetomidine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D007362:Intensive Care Units / Q000458:organization & administration; D007558:Italy; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D015300:Ventilator Weaning / Q000592:standards*
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol
keywords: Dexmedetomidine; Mechanical ventilation; Patient-ventilator synchrony; Propofol; Sedation