Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation

Ruokonen, Esko; Parviainen, Ilkka; Jakob, Stephan M; Nunes, Silvia; Kaukonen, Maija; Shepherd, Stephen T; Sarapohja, Toni; Bratty, J Raymond; Takala, Jukka (2009). Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation. Intensive care medicine, 35(2), pp. 282-90. Berlin: Springer-Verlag 10.1007/s00134-008-1296-0

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PURPOSE: 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Jakob, Stephan and Takala, Jukka

ISSN:

0342-4642

ISBN:

18795253

Publisher:

Springer-Verlag

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:04

Last Modified:

23 Oct 2019 06:02

Publisher DOI:

10.1007/s00134-008-1296-0

PubMed ID:

18795253

Web of Science ID:

000263160600013

BORIS DOI:

10.7892/boris.27827

URI:

https://boris.unibe.ch/id/eprint/27827 (FactScience: 112355)

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