Patricia Kritek, MD reviewing Kawazoe Y et al. JAMA 2017 Apr 4.

Patients with sepsis had similar outcomes when sedated with or without dexmedetomidine.

Multiple recent trials have yielded mixed results on whether dexmedetomidine for sedation during mechanical ventilation prevents delirium. Interestingly, however, one such study suggested markedly lower mortality in septic patients who were sedated with dexmedetomidine (Crit Care 2010; 14:R38). To study this potential effect, Japanese investigators randomized 201 mechanically ventilated sepsis patients (mean age, 69) to sedation with or without dexmedetomidine. The patients in the control arm received either propofol or midazolam, based on local practice and physician preference.

No significant differences were found between the groups at 28 days in mortality or number of ventilator-free days. Although patients treated with dexmedetomidine were more likely to achieve targeted sedation goals, development of delirium or coma was similar in both groups. Amount of fentanyl needed for adequate analgesia was the same in the two groups.

CITATION(S):

Kawazoe Y et al. Effect of dexmedetomidine on mortality and ventilator-free days in patients requiring mechanical ventilation with sepsis: A randomized clinical trial. JAMA 2017 Apr 4; 317:1321. 

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