- For adults requiring mechanical ventilation (MV), sedation with dexmedetomidine (Precedex, Hospira) does not result in higher survival rates vs usual care with other sedatives.
Why this matters
- Dexmedetomidine allows for some arousability.
- Its use has been linked to shorter time to extubation, less delirium, and lower mortality.
- Few data address use of dexmedetomidine as sole sedative in patients undergoing MV.
- Dexmedetomidine vs usual care:
- Primary outcome: 29.1% vs 29.1%;
- Adjusted risk difference, 0.0 percentage points (95% CI, −2.9 to 2.8; P=.98).
- Sensitivity analyses, secondary outcomes did not reveal differences.
- Dexmedetomidine group patients typically required additional sedatives.
- More adverse events in dexmedetomidine group, mostly bradycardia and hypotension.
- Multinational randomized controlled open-label SPICE III trial (n=3904).
- Critically ill adults undergoing MV for
- Target sedation: light.
- Outcome: 90-day all-cause mortality.
- Funding: National Health and Medical Research Council (Australia), Health Research Council (New Zealand), Institut Jantung Negara Foundation (Malaysia).