Sedation with dexmedetomidine in critically ill patients

Dexmedetomidine is used to sedate patients while maintaining a certain degree of sustainability. The use of dexmedetomidine is known to reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU). However, its use as the sole sedative agent in patients undergoing mechanical ventilation has not been studied extensively.

An open-label, randomised trial was conducted with 4000 critically ill adults who had been undergoing ventilation for less than 12 hours in the ICU. These patients were expected to receive ventilator support for longer than the next calendar day. Patients either received dexmedetomidine as the sole sedative or usual care with propofol, midazolam, or other sedatives. The primary outcome of the trial was the rate of death from any cause at 90 days and the target range of sedation-scores on the Richmond Agitation and Sedation Scale was -2 to +1 (lightly sedated to restless).

As per the results of the trial, the primary outcome event occurred in 566 of 1948 patients in the dexmedetomidine group, and in 569 of 1956 patients in the usual-care group. In order to achieve the required level of sedation, patients in the dexmedetomidine group received supplemental propofol, midazolam, or both during the first two days after randomisation, while the same drugs were administered as primary sedatives in the usual-care group. It was observed that the incidence of bradycardia and hypotension was more common in the dexmedetomidine group.

Findings from this trial suggest that patients undergoing mechanical ventilation in the ICU and who received dexmedetomidine for sedation had a similar rate of death at 90 days compared to the usual-care group. The dexmedetomidine group needed supplemental sedatives to achieve the required level of sedation. Overall, the dexmedetomidine group reported more adverse events compared to the usual-care group.