Authors: Kawazoe Y et al., JAMA 2017 Apr 4; 317:1321
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.
This study might have been underpowered to detect a mortality difference, but the take-home message is that dexmedetomidine didn’t significantly affect clinically important outcomes in septic patients. Dexmedetomidine should be seen as a reasonable alternative to other sedative agents in the intensive care unit, but it is not a preferred agent in septic patients.