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

Esko Ruokonen, Ilkka Parviainen, Stephan M Jakob, Silvia Nunes, Maija Kaukonen, Stephen T Shepherd, Toni Sarapohja, J Raymond Bratty, Jukka Takala, "Dexmedetomidine for Continuous Sedation" Investigators, Jukka Takala, Esko Ruokonen, Stephan M Jakob, Anna Brunello, Barbara Haeberli, Klaus Maier, Jürgen Rohner, Judith Kaufmann, Kirsi-Maija Kaukonen, Maiju Salovaara-Hiltunen, Esko Ruokonen, Ilkka Parviainen, Ari Uusaro, Kirsimarja Metsävainio, Stepani Bendel, Jouni Kurola, Valdo Toome, Sari Rahikainen, Elina Halonen, Heikki Ahonen, Seija Laitinen, Silvia Nunes, Sari Karlsson, Pertti Arvola, Markku Suvela, Jyrki Tenhunen, Riitta Halmela, Anna-Liina Korkala, Minna-Liisa Peltola, Samuli Kortelainen, Stephen T Shepherd, J Raymond Bratty, Pasi Pohjanjousi, Toni Sarapohja, Tuula Ahtola-Sätilä, Marja Kelloniemi, Angela Ruck, Esko Ruokonen, Ilkka Parviainen, Stephan M Jakob, Silvia Nunes, Maija Kaukonen, Stephen T Shepherd, Toni Sarapohja, J Raymond Bratty, Jukka Takala, "Dexmedetomidine for Continuous Sedation" Investigators, Jukka Takala, Esko Ruokonen, Stephan M Jakob, Anna Brunello, Barbara Haeberli, Klaus Maier, Jürgen Rohner, Judith Kaufmann, Kirsi-Maija Kaukonen, Maiju Salovaara-Hiltunen, Esko Ruokonen, Ilkka Parviainen, Ari Uusaro, Kirsimarja Metsävainio, Stepani Bendel, Jouni Kurola, Valdo Toome, Sari Rahikainen, Elina Halonen, Heikki Ahonen, Seija Laitinen, Silvia Nunes, Sari Karlsson, Pertti Arvola, Markku Suvela, Jyrki Tenhunen, Riitta Halmela, Anna-Liina Korkala, Minna-Liisa Peltola, Samuli Kortelainen, Stephen T Shepherd, J Raymond Bratty, Pasi Pohjanjousi, Toni Sarapohja, Tuula Ahtola-Sätilä, Marja Kelloniemi, Angela Ruck

Abstract

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.

Trial registration: ClinicalTrials.gov NCT00226785.

References

    1. Crit Care Med. 2005 May;33(5):940-5
    1. JAMA. 2001 Dec 5;286(21):2703-10
    1. Intensive Care Med. 1999 Jun;25(6):634-6
    1. Anesth Analg. 2000 Mar;90(3):699-705
    1. Anesth Analg. 2002 Oct;95(4):1052-9, table of contents
    1. Anesthesiology. 1992 Dec;77(6):1134-42
    1. Intensive Care Med. 2004 Dec;30(12):2188-96
    1. Anesth Analg. 1999 Aug;89(2):514-9
    1. Crit Care. 2005 Jun;9(3):247-8
    1. Anesthesiology. 2000 Aug;93(2):382-94
    1. Crit Care. 2000;4(5):302-8
    1. J Cardiothorac Vasc Anesth. 2003 Oct;17(5):576-84
    1. Crit Care Med. 1999 Dec;27(12):2609-15
    1. N Engl J Med. 2000 May 18;342(20):1471-7
    1. JAMA. 1997 Jul 9;278(2):144-51
    1. JAMA. 2007 Dec 12;298(22):2644-53
    1. Intensive Care Med. 2003 Feb;29(2):201-7
    1. Eur J Pharmacol. 1988 May 20;150(1-2):9-14
    1. Respir Care. 2006 May;51(5):492-6
    1. Intensive Care Med. 1996 Jul;22(7):707-10
    1. Pharmacotherapy. 2007 Mar;27(3):351-9
    1. Am J Respir Crit Care Med. 2002 Nov 15;166(10):1338-44
    1. Br J Anaesth. 2001 Nov;87(5):684-90

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit