Sedative may reduce duration of mechanical ventilation, improve comfort for ICU patients
The results of two randomized trials indicate that among intensive care unit (ICU) patients receiving prolonged mechanical ventilation, use of the sedative dexmedetomidine was not inferior (outcome not worse than treatment compared to) to the standard sedatives midazolam and propofol in maintaining light to moderate sedation; also, dexmedetomidine reduced the duration of mechanical ventilation compared with midazolam, and improved patients' ability to communicate pain compared with the other drugs, according to a study in the March 21 issue of JAMA.
Sedation in ICU patients is assumed to reduce discomfort from care interventions and increase tolerance of mechanical ventilation, although long-term sedation with midazolam or propofol in ICUs can have serious adverse effects. Research has suggested that dexmedetomidine may enhance patient safety and comfort in long-term sedation. "However, a recent meta-analysis presented inconclusive results for the effect of dexmedetomidine on duration of mechanical ventilation and ICU stay. Most clinicians and centers do not consider midazolam and propofol as equivalent alternatives for long-term sedation," according to background information in the article.
Stephan M. Jakob, M.D., Ph.D., of Bern University Hospital and the University of Bern, Switzerland, and colleagues conducted 2 large, randomized controlled trials to assess whether dexmedetomidine is noninferior to midazolam or propofol in maintaining mild to moderate sedation and offers benefits in terms of reduced mechanical ventilation and ICU stay and patients' ability to communicate during sedation. The two trials (MIDEX and PRODEX) were carried out from 2007 to 2010. The MIDEX trial compared midazolam with dexmedetomidine in ICUs of 44 centers in 9 European countries; the PRODEX trial compared propofol with dexmedetomidine in 31 centers in 6 European countries and 2 centers in Russia. Included were adult ICU patients receiving mechanical ventilation who needed light to moderate sedation for more than 24 hours (midazolam, n =251, vs. dexmedetomidine, n = 249; propofol, n = 247, vs. dexmedetomidine, n = 251).
The researchers found that dexmedetomidine was not inferior to midazolam or propofol for long-term sedation in mechanically ventilated ICU patients. Dexmedetomidine appeared to shorten duration of ventilation compared with midazolam but not compared with propofol; however, time to extubation (tube removal) was reduced compared with both midazolam and propofol.
The authors also found that patients receiving dexmedetomidine were more arousable, more cooperative, and better able to communicate their pain than patients receiving either midazolam or propofol.
Length of ICU and hospital stay and mortality were similar between groups. Dexmedetomidine vs. midazolam patients had more hypotension (abnormally low blood pressure) (20.6 percent vs. 11.6 percent) and bradycardia (abnormally slow heartbeat) (14.2 percent vs. 5.2 percent).
"... dexmedetomidine may provide clinically relevant benefits compared with standard sedation, even when measures to reduce the risks of oversedation are implemented. The better arousability and ability to communicate pain should allow more appropriate use of opioids and facilitate earlier mobilization and functional recovery," the researchers write.
In an accompanying editorial, Hannah Wunsch, M.D., M.Sc., of Columbia University, New York, writes that the higher cost of dexmedetomidine may hinder its use at this time.
"These 2 randomized controlled trials 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. But with the focus on cost containment at many hospitals, consideration of expense may preclude broad use without more tangible long-term outcome data and without confirmation that the benefits are due to the choice of sedative and not solely the lighter sedation levels achieved. Dexmedetomidine comes off patent in the United States in 2013. When there is no longer a need to weigh the drug acquisition costs, even uncertain improvements in the patient experience should be justification enough for broader use of dexmedetomidine in the ICU."
More information: JAMA. 2012;307[11]:1151-1160.
JAMA. 2012;307[11]:1195-1197.
Provided by
JAMA and Archives Journals
-
Newer medication may offer advantages over agents often used for sedation in ICU
Feb 02, 2009 |
not rated yet |
0
-
Intensive care quality of sleep improved by new drug, reports study
Dec 12, 2007 |
not rated yet |
0
-
Study compares balanced propofol sedation with conventional sedation for therapeutic GI endoscopic procedures
Feb 15, 2011 |
not rated yet |
0
-
Research offers road map to safer pain control, cost savings during colonoscopies
Mar 11, 2008 |
not rated yet |
0
-
Adverse events rate is low when propofol is administered by trained professional
Mar 03, 2010 |
not rated yet |
0
-
Motion perception revisited: High Phi effect challenges established motion perception assumptions
Apr 23, 2013 |
3 / 5 (2) |
2
-
Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update)
Apr 02, 2013 |
4.5 / 5 (11) |
5
-
The visual system as economist: Neural resource allocation in visual adaptation
Mar 30, 2013 |
5 / 5 (2) |
9
-
Separate lives: Neuronal and organismal lifespans decoupled
Mar 27, 2013 |
4.9 / 5 (8) |
0
-
Sizing things up: The evolutionary neurobiology of scale invariance
Feb 28, 2013 |
4.8 / 5 (10) |
14
-
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011
- More from Physics Forums - Independent Research
More news stories
Plastic realistic: Medical students to use plastinated human bodies for anatomy learning
Nanyang Technological University's (NTU) new medical school will be pioneering the use of plastinated bodies for medical education in Singapore.
Other
25 minutes ago |
not rated yet |
0
Survey points out deficiencies in addictions training for medical residents
A 2012 survey of internal medicine residents at Massachusetts General Hospital (MGH) – one of the nation's leading teaching hospitals – found that more than half rated the training they had received in addiction and other ...
Other
17 hours ago |
not rated yet |
0
Early use of tracheostomy for mechanically ventilated patients not associated with improved survival
For critically ill patients receiving mechanical ventilation, early tracheostomy (within the first 4 days after admission) was not associated with an improvement in the risk of death within 30 days compared to patients who ...
Other
May 21, 2013 |
not rated yet |
0
Decisions to forgo life support may depend heavily on the ICU where patients are treated
The decision to limit life support in patients in the intensive care unit (ICU) appears to be significantly influenced by physician practices and/or the culture of the hospital, suggests new findings from researchers at the ...
Other
May 21, 2013 |
not rated yet |
0
People on higher incomes are happier with new knees
Knee replacement surgery is a very common procedure. However, it does not always resolve function or pain in all the recipients of new knees. A study by Robert Barrack, MD and his colleagues from the Washington University ...
Other
May 21, 2013 |
not rated yet |
0
Cold plasma successful against brain cancer cells
For the first time, physicists from the Max Planck Institute for Extraterrestrial Physics (MPE), biologists and physicians demonstrated the synergistic effect of cold atmospheric plasma - a partly ionized ...
Can you put a price on health?
As health services strive to improve quality and reduce costs, researchers study the benefits – and the pitfalls – of 'pay for performance' in hospitals.
Study reveals active site of enzyme linked to stuttering
(Medical Xpress)—Scientists from the Joint Center for Structural Genomics (JCSG) at SLAC National Accelerator Laboratory have determined the 3-D structure of the chemically active part of an enzyme involved ...
Are kids who take music lessons different from other kids?
(Medical Xpress)—Research by U of T Mississauga psychology professor Glenn Schellenberg reveals that two key personality traits – openness-to-experience and conscientiousness—predict better than IQ ...
Researchers develop sperm-sorting design that may aid couples undergoing in vitro fertilization
(Medical Xpress)—According to the World Health Organization, approximately 70 million couples experience infertility worldwide. Current data suggests that nearly one third of infertility disorders are due ...
Key find for early bladder cancer treatment
Aggressive forms of bladder cancer involve the protein PODXL – a discovery that could hold the key to improved treatment, according to researchers at Lund University, Uppsala University and KTH in Sweden.