| Title: |
Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis |
| Authors: |
Hughes, Christopher G; Mailloux, Patrick T; Devlin, John W; Swan, Joshua T; Sanders, Robert D; Anzueto, Antonio; Jackson, James C; Hoskins, Aimee S; Pun, Brenda T; Orun, Onur M; Raman, Rameela; Stollings, Joanna L; Kiehl, Amy L; Duprey, Matthew S; Bui, Lan N; O'Neal, Hollis R; Snyder, Allison; Gropper, Michael A; Guntupalli, Kalpalatha K; Stashenko, Gregg J; Patel, Mayur B; Brummel, Nathan E; Girard, Timothy D; Dittus, Robert S; Bernard, Gordon R; Ely, E Wesley; Pandharipande, Pratik P; MENDS2 Study Investigators |
| Source: |
Faculty and Staff Publications |
| Publisher Information: |
DigitalCommons@TMC |
| Publication Year: |
2021 |
| Collection: |
Houston Academy of Medicine-Texas Medical Center (HAM-TMC): DigitalCommons@The Texas Medical Center |
| Subject Terms: |
Adult; Cognition; Conscious Sedation; Critical Illness; Dexmedetomidine; Double-Blind Method; Humans; Hypnotics and Sedatives; Kaplan-Meier Estimate; Propofol; Respiration; Artificial; Sepsis; Biochemistry; Biophysics; and Structural Biology; Medical Sciences; Medical Specialties; Medicine and Health Sciences |
| Description: |
BACKGROUND: Guidelines currently recommend targeting light sedation with dexmedetomidine or propofol for adults receiving mechanical ventilation. Differences exist between these sedatives in arousability, immunity, and inflammation. Whether they affect outcomes differentially in mechanically ventilated adults with sepsis undergoing light sedation is unknown. METHODS: In a multicenter, double-blind trial, we randomly assigned mechanically ventilated adults with sepsis to receive dexmedetomidine (0.2 to 1.5 μg per kilogram of body weight per hour) or propofol (5 to 50 μg per kilogram per minute), with doses adjusted by bedside nurses to achieve target sedation goals set by clinicians according to the Richmond Agitation-Sedation Scale (RASS, on which scores range from -5 [unresponsive] to +4 [combative]). The primary end point was days alive without delirium or coma during the 14-day intervention period. Secondary end points were ventilator-free days at 28 days, death at 90 days, and age-adjusted total score on the Telephone Interview for Cognitive Status questionnaire (TICS-T; scores range from 0 to 100, with a mean of 50±10 and lower scores indicating worse cognition) at 6 months. RESULTS: Of 432 patients who underwent randomization, 422 were assigned to receive a trial drug and were included in the analyses - 214 patients received dexmedetomidine at a median dose of 0.27 μg per kilogram per hour, and 208 received propofol at a median dose of 10.21 μg per kilogram per minute. The median duration of receipt of the trial drugs was 3.0 days (interquartile range, 2.0 to 6.0), and the median RASS score was -2.0 (interquartile range, -3.0 to -1.0). We found no difference between dexmedetomidine and propofol in the number of days alive without delirium or coma (adjusted median, 10.7 vs. 10.8 days; odds ratio, 0.96; 95% confidence interval [CI], 0.74 to 1.26), ventilator-free days (adjusted median, 23.7 vs. 24.0 days; odds ratio, 0.98; 95% CI, 0.63 to 1.51), death at 90 days (38% vs. 39%; hazard ratio, 1.06; 95% CI, 0.74 ... |
| Document Type: |
text |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
https://digitalcommons.library.tmc.edu/baylor_docs/871; https://digitalcommons.library.tmc.edu/context/baylor_docs/article/1862/viewcontent/nihms_1701628.pdf |
| DOI: |
10.1056/NEJMoa2024922 |
| Availability: |
https://digitalcommons.library.tmc.edu/baylor_docs/871; https://doi.org/10.1056/NEJMoa2024922; https://digitalcommons.library.tmc.edu/context/baylor_docs/article/1862/viewcontent/nihms_1701628.pdf |
| Accession Number: |
edsbas.A575A09D |
| Database: |
BASE |