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Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients: a rapid practice guideline

  • ICM Rapid Practice Guidelines
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM‑RPG) was to formulate evidence‑based guidance for the use of dexmedetomidine for sedation in invasively mechanically ventilated adults in the intensive care unit (ICU).

Methods

We adhered to the methodology for trustworthy clinical practice guidelines, including use of the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence, and the Evidence-to-Decision framework to generate recommendations. The guideline panel comprised 28 international panelists, including content experts, ICU clinicians, methodologists, and patient representatives. Through teleconferences and web‑based discussions, the panel provided input on the balance and magnitude of the desirable and undesirable effects, the certainty of evidence, patients’ values and preferences, costs and resources, feasibility, acceptability, and research priorities.

Results

The ICM‑RPG panel issued one weak recommendation (suggestion) based on overall moderate certainty of evidence: "In invasively mechanically ventilated adult ICU patients, we suggest using dexmedetomidine over other sedative agents, if the desirable effects including a reduction in delirium are valued over the undesirable effects including an increase in hypotension and bradycardia".

Conclusion

This ICM-RPG provides updated evidence-based guidance on the use of dexmedetomidine for sedation in mechanically ventilated adults, and outlines uncertainties and research priorities.

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Acknowledgements

We are very grateful to the patient representatives Olaf Schroeder and Maria Høpner for being members of the guideline panel.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Morten H. Møller & Anders Granholm

  2. Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada

    Waleed Alhazzani & Kimberley Lewis

  3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Waleed Alhazzani & Jessica Spence

  4. Divisions of Cardiology and Critical Care, McMaster University, Hamilton, ON, Canada

    Emilie Belley-Cote

  5. Department of Anesthesia, McMaster University, Hamilton, ON, Canada

    John Centofanti

  6. Population Health Research Institute, Hamilton, ON, Canada

    William B. McIntyre

  7. Department of Medicine, McMaster University, Hamilton, ON, Canada

    William B. McIntyre

  8. Department of Anesthesia and Critical Care, McMaster University, Hamilton, ON, Canada

    Jessica Spence

  9. Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

    Zainab Al Duhailib

  10. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA

    Dale M. Needham

  11. Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, USA

    Laura Evans

  12. Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia

    Annika Reintam Blaser

  13. Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland

    Annika Reintam Blaser

  14. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, 06501, USA

    Margaret A. Pisani

  15. Department of Anesthesiology, Universite de Sherbrooke, Sherbrooke, QC, Canada

    Frederick D’Aragon

  16. Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

    Frederick D’Aragon

  17. Centre for Inflammation Research, The University of Edinburgh The Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK

    Manu Shankar-Hari

  18. Department of Emergency and Critical Care, College of Medicine, Imam Abdulrahman Ben Faisal University, Dammam, Saudi Arabia

    Mohammed Alshahrani

  19. School of Medicine and Surgery, University Milano–Bicocca; Neurorianimazione, ASST-Monza, Monza, Italy

    Giuseppe Citerio

  20. Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

    Rakesh C. Arora

  21. Department of Medicine, Sinai Health, and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada

    Sangeeta Mehta

  22. Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Timothy D. Girard

  23. Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain

    Otavio T. Ranzani

  24. Pulmonary Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, São Paulo, SP, Brazil

    Otavio T. Ranzani

  25. Critical Care Program, The George Institute for Global Health and UNSW Sydney, Newtown, NSW, Australia

    Naomi Hammond

  26. Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia

    Naomi Hammond

  27. Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    John W. Devlin

  28. School of Pharmacy, Northeastern University, Boston, MA, USA

    John W. Devlin

  29. Department of Intensive Care, Monash Health School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia

    Yahya Shehabi

  30. School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2031, Australia

    Yahya Shehabi

  31. Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA

    Pratik Pandharipande

  32. Department of Critical Care, King’s College London, Guy’s & St Thomas’ Hospital, London, UK

    Marlies Ostermann

Authors
  1. Morten H. Møller
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  2. Waleed Alhazzani
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  3. Kimberley Lewis
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  4. Emilie Belley-Cote
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  5. Anders Granholm
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  6. John Centofanti
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  7. William B. McIntyre
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  8. Jessica Spence
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  9. Zainab Al Duhailib
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  10. Dale M. Needham
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  11. Laura Evans
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  12. Annika Reintam Blaser
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  13. Margaret A. Pisani
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  14. Frederick D’Aragon
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  15. Manu Shankar-Hari
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  16. Mohammed Alshahrani
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  17. Giuseppe Citerio
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  18. Rakesh C. Arora
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  19. Sangeeta Mehta
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  20. Timothy D. Girard
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  21. Otavio T. Ranzani
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  22. Naomi Hammond
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  23. John W. Devlin
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  24. Yahya Shehabi
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  25. Pratik Pandharipande
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  26. Marlies Ostermann
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Corresponding author

Correspondence to Morten H. Møller.

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All co-authors declared their conflicts of interests (Supplementary Material).

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Møller, M.H., Alhazzani, W., Lewis, K. et al. Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients: a rapid practice guideline. Intensive Care Med 48, 801–810 (2022). https://doi.org/10.1007/s00134-022-06660-x

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  • DOI: https://doi.org/10.1007/s00134-022-06660-x

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