Intensive Care Medicine

, Volume 35, Issue 2, pp 282–290

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

Authors

  • Esko Ruokonen
    • Department of Anesthesiology and Intensive Care MedicineKuopio University Hospital
  • Ilkka Parviainen
    • Department of Anesthesiology and Intensive Care MedicineKuopio University Hospital
  • Stephan M. Jakob
    • Department of Intensive Care MedicineBern University Hospital and University of Bern
  • Silvia Nunes
    • Department of Intensive CareTampere University Hospital
  • Maija Kaukonen
    • Units of Intensive Care Medicine, Division of Anesthesiology and Intensive Care Medicine, Department of SurgeryHelsinki University Central Hospital
  • Stephen T. Shepherd
    • Orion Pharma
  • Toni Sarapohja
    • Orion Pharma
  • J. Raymond Bratty
    • Orion Pharma
    • Department of Intensive Care MedicineBern University Hospital and University of Bern
  • For the “Dexmedetomidine for Continuous Sedation” Investigators
Original

DOI: 10.1007/s00134-008-1296-0

Cite this article as:
Ruokonen, E., Parviainen, I., Jakob, S.M. et al. Intensive Care Med (2009) 35: 282. doi:10.1007/s00134-008-1296-0

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 ≥48 h and sedation need for ≥24 h after randomization. Patients were assigned to either DEX (≤1.4 μg 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.

Keywords

DexmedetomidineSedativesDeep sedationConscious sedationIntensive careCritical careMechanical ventilation

Supplementary material

134_2008_1296_MOESM1_ESM.doc (238 kb)
Electronic supplementary material (DOC 238 kb)

Copyright information

© Springer-Verlag 2008