Comparison of dexmedetomidine and propofol in mechanically ventilated patients with sepsis: A pilot study
Abstract
Objective: To compare the effects of a propofol-based versus dexmedetomidine-based sedation regimen for mechanically ventilated patients with sepsis.
Methods: Single-center, randomized, open-label interventional study of critically ill patients admitted to the intensive care unit with sepsis and respiratory failure requiring mechanical ventilation. Patients were sedated with either propofol or dexmedetomidine.
Results: Thirty-six patients with sepsis and respiratory failure requiring mechanical ventilation were randomly assigned to receive sedation with either dexmedetomidine or propofol. Fentanyl was used for analgesia in both groups. The primary end point was duration of mechanical ventilation, and secondary end points included 28-day mortality, the duration of ICU stay, and the duration of vasopressor support. There was a non-statistically significant trend toward decreased duration of mechanical ventilation in the dexmedetomidine group (p = 0.107), and multivariable analysis demonstrated a small to moderate effect size in the sample. There were no significant differences in 28-day mortality, duration of ICU stay, or duration of vasopressor requirement. No patients required discontinuation of study drug due to adverse effects.
Conclusions: Although underpowered for statistical significance, there was a trend toward decreased duration of mechanical ventilation with dexmedetomidine. More studies with higher patient enrollment are needed to determine whether the duration of mechanical ventilation in patients with sepsis who receive sedation with dexmedetomidine is reduced when compared to propofol.
Keywords: sepsis, respiratory failure, ventilators, mechanical, propofol, dexmedetomidine, sedation
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References
Wunsch H, Kahn JM, Kramer AA, et al. Use of intravenous
infusion sedation among mechanically ventilated patients in
the United States. Crit Care Med 2009;37:3031–3039.
Tan JA, Ho KM: Use of dexmedetomidine as a sedative
and analgesic agent in critically ill adult patients: A meta-analysis.
Intensive Care Med 2010;36:926–939.
Barr J, Fraser GL, Puntillo K, et al. Clinical Practice Guidelines
for the Management of Pain, Agitation, and Delirium
in Adult Patients in the Intensive Care Unit. Crit Care Med
;41:263–306.
Gertler R, Brown HC, Mitchell DH, et al. Dexmedetomidine:
a novel sedative-analgesic agent. BUMC Proceedings
;14:13–21.
Belleville JP, Ward DS, Bloor BC, et al: Effects of intravenous
dexmedetomidine in humans. I. Sedation, ventilation,
and metabolic rate. Anesthesiology 1992;77:1125–1133.
Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation
with dexmedetomidine vs lorazepam on acute brain dysfunction
in mechanically ventilated patients. JAMA 2007;298:
–2653.
Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine
vs midazolam for sedation of critically ill patients. JAMA
;301:489–499.
Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine
vs midazolam or propofol for sedation during prolonged
mechanical ventilation. JAMA 2012;307:1151–1160.
Pandharipande PP, Sanders RD, Girard TD. Effect of dexmedetomidine
versus lorazepam on outcome in patients with
sepsis: an a priori-designed analysis of the MENDS randomized
controlled trial. Critical Care 2010;14:R38.
Sanders RD, Hussell T, Maze M. Sedation & Immunomodulation.
Crit Care Clin 2009;25(551–570).
Taniguchi T, Kidani Y, Kanakura H, et al. Effects of dexmedetomidine
on mortality rate and inflammatory responses
to endotoxin-induced shock in rats. Crit Care Med 2004;32:
–1326.
Taniguchi T, Kurita A, Kobayashi K, et al. Dose- and
time-related effects of dexmedetomidine on mortality and
inflammatory responses to endotoxin-induced shock in rats.
J Anesth 2008;22:221–228.
Fong JJ, Kanji S, Dasta JF, et al. Propofol associated with
a shorter duration of mechanical ventilation than scheduled
intermittent lorazepam: A database analysis using Project
IMPACT. Ann Pharmacother 2007;41:1986–1991.
Esmaoglu A, Ulgey A, Akin A, et al. Comparison
between dexmedetomidine and midazolam for sedation of
eclampsia patients in the intensive care unit. J Crit Care
;24:551–555.
Klompas M, Lingling L, Szumita P, et al. Associations
between different sedatives and ventilator-associated events,
length of stay, and mortality in patients who were mechanically
ventilated. Chest 2016;149:1373–1379.
