Ventilated ICU patients: dexmedetomidine disappoints

  • Shehabi Y & al.
  • N Engl J Med
  • 19 May 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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).

Limitations

  • Unblinded.

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