Dexmedetomidine Non Inferior for Maintaining Sedation

Dexmedetomidine not inferior to midazolam or propofol during prolonged mechanical ventilation

WEDNESDAY, March 21 (HealthDay News) -- The α2-agonist dexmedetomidine is not inferior to the standard sedatives midazolam or propofol in its ability to maintain light-to-moderate sedation during mechanical ventilation, according to research published in the March 21 issue of the Journal of the American Medical Association.

To investigate the efficacy of dexmedetomidine for sedation during prolonged mechanical ventilation, Stephan M. Jakob, M.D., Ph.D., of the Bern University Hospital in Switzerland, and colleagues conducted two randomized, double-blind trials, the MIDEX trial and the PRODEX trial, involving adult intensive care unit patients receiving mechanical ventilation who required light-to-moderate sedation for longer than 24 hours. In the MIDEX trial, 251 patients received midazolam and 249 received dexmedetomidine; in the PRODEX trial, 247 patients received propofol and 251 received dexmedetomidine.

The researchers found that time at target sedation was similar for all sedatives. The median duration of mechanical ventilation with dexmedetomidine was significantly shorter compared with midazolam, but not compared with propofol. Patients were better able to communicate pain to nursing staff with dexmedetomidine treatment compared with either midazolam or propofol. The duration of hospital and intensive care unit stay and mortality rates did not differ significantly between the treatment groups. However, dexmedetomidine was associated with more hypotension and bradycardia than midazolam.

"These two randomized controlled trails provide important evidence that dexmedetomidine is an effective sedative compared with both midazolam and propofol, and its use may be associated with decreased time to extubation, easier communication with patients, and better assessment of pain," writes the author of an accompanying editorial.

Several authors disclosed financial ties to pharmaceutical and nutrition companies, including Orion Pharma, which funded the study and is the originator of dexmedetomidine.

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