Sedatives Effective for Critically Ill on Ventilation

Dexmedetomidine associated with less delirium and less time to extubation

MONDAY, Feb. 2 (HealthDay News) -- Dexmedetomidine is similar to midazolam in effectively sedating critically ill patients on mechanical ventilation for prolonged periods, but with less delirium and shorter time to extubation, according to research published online Feb. 2 in the Journal of the American Medical Association, released early to coincide with the Society of Critical Care Medicine's annual meeting in Nashville.

Richard R. Riker, M.D., from Maine Medical Center in Portland, Maine, and colleagues randomly assigned 366 patients receiving mechanical ventilation in the intensive care unit to sedation with dexmedetomidine (244 patients) or midazolam (122 patients) for up to 30 days.

The investigators found that both groups had similar percentages of time within the target range of sedation levels and delirium, as assessed by the Richmond Agitation-Sedation Scale. Fewer dexmedetomidine-treated patients experienced delirium (54 versus 76.6 percent) and median time to extubation was significantly shorter (3.7 versus 5.6 days), the researchers report. Both groups spent similar amounts of time in the intensive care unit. More dexmedetomidine-treated patients developed bradycardia but fewer developed tachycardia or hypertension that required treatment, the authors note.

"With the demonstration of the safety of dexmedetomidine at higher doses and for longer periods, clinicians now have a widened choice of sedatives and should always consider not only the need for sedation but also the possible clinical implications of the choice of sedative," the authors of an accompanying editorial write.

The study was funded by Hospira Inc. of Lake Forest, Ill., manufacturers of dexmedetomidine. Several authors have disclosed financial relationships with various pharmaceutical companies, including Hospira.

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