A Randomized, Double-Blind Pilot Study of Dexmedetomidine Versus Midazolam for Intensive Care Unit Sedation

MacLaren, Robert; Preslaski, Candice; Mueller, Scott W.; Kiser, Tyree H.; Fish, Douglas N.; Lavelle, James; Malkoski, Stephen P.

doi:10.1177/0885066613510874

Cited by 39 publications

(25 citation statements)

References 32 publications

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“…Twenty-seven articles were excluded because 20 investigated sedation protocol that the type of sedative drugs could not be identified, 4 studies were secondary analysis of previous reports, and 3 were study protocols. As a result, a total of 51 citations comprising 52 RCTs were included in our analysis141516171819202122232425262728293031323334353637383940414243444546474849505152535455565758596061626364. The article by Jakob and colleagues comprised two RCTs38.…”

Section: Resultsmentioning

confidence: 99%

Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis

Zhang

Chen

et al. 2017

Sci Rep

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Sedatives are commonly used for mechanically ventilated patients in intensive care units (ICU). However, a variety of sedatives are available and their efficacy and safety have been compared in numerous trials with inconsistent results. To resolve uncertainties regarding usefulness of these sedatives, we performed a systematic review and network meta-analysis. Randomized controlled trials comparing sedatives in mechanically ventilated ICU patients were included. Graph-theoretical methods were employed for network meta-analysis. A total of 51 citations comprising 52 RCTs were included in our analysis. Dexmedetomidine showed shorter MV duration than lorazepam (mean difference (MD): 68.7; 95% CI: 18.2–119.3 hours), midazolam (MD: 10.2; 95% CI: 7.7–12.7 hours) and propofol (MD: 3.4; 95% CI: 0.9–5.9 hours). Compared with dexmedetomidine, midazolam was associated with significantly increased risk of delirium (OR: 2.47; 95% CI: 1.17–5.19). Our study shows that dexmedetomidine has potential benefits in reducing duration of MV and lowering the risk of delirium.

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Section: Resultsmentioning

confidence: 99%

Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis

Zhang

Chen

et al. 2017

Sci Rep

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“…46 MacLaren et al showed a lower incidence of delirium without more adverse reactions. 47 Ozaki et al studied the use of continuous infusion of dexmedetomidine in pediatric setting, for longer than the recommended time of 48 hours and at doses of 0.7 mcg/kg/h. The patients reached a good level of sedation with the use of the drug for nearly 6 days, with no more adverse events, rebound symptoms or abstinence.…”

Section: Resultsmentioning

confidence: 99%

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Motta

Luglio²,

Delgado

et al. 2016

Rev. Assoc. Med. Bras.

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Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

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“…Although these medications are intended to reduce stress, anxiety, and oxygen consumption, they often produce long periods of unconsciousness. Further, the efficacy of these medications for symptom management is questionable; patients still report persistent symptoms of anxiety and pain 5,9 while receiving these medications, leading to increased doses for extended periods without any clear benefit. 10 Anxiety requires ongoing symptom management throughout the course of mechanical ventilation because patients continue to report moderate anxiety regardless of the duration of mechanical ventilation and despite receiving sedative medications.…”

Section: Background and Significance Of Anxiety In Critically Ill Patmentioning

confidence: 99%

“…10 Anxiety requires ongoing symptom management throughout the course of mechanical ventilation because patients continue to report moderate anxiety regardless of the duration of mechanical ventilation and despite receiving sedative medications. 4,9,10 Current research on ICU symptoms and sedation management focuses on pharmacological strategies only to manage patients' symptoms despite the documented deleterious effects of sedative agents such as hypotension, delayed weaning, immobility, and delirium. [2][3][4][5][6][7][8][9][10] However, it is recommended that symptoms of ICU patients receiving mechanical ventilation be managed without sedation 11 or if necessary, with minimum use of sedative agents, giving the brain a chance to clear the medications acting on the central nervous system.…”

Section: Background and Significance Of Anxiety In Critically Ill Patmentioning

confidence: 99%

“…4,9,10 Current research on ICU symptoms and sedation management focuses on pharmacological strategies only to manage patients' symptoms despite the documented deleterious effects of sedative agents such as hypotension, delayed weaning, immobility, and delirium. [2][3][4][5][6][7][8][9][10] However, it is recommended that symptoms of ICU patients receiving mechanical ventilation be managed without sedation 11 or if necessary, with minimum use of sedative agents, giving the brain a chance to clear the medications acting on the central nervous system. 12 Further, clinical practice guidelines suggest that if a patient requires sedation, the patient should be only "lightly sedated" and symptoms should be interactively assessed.…”

Section: Background and Significance Of Anxiety In Critically Ill Patmentioning

confidence: 99%

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Engaging Critically Ill Patients in Symptom Management: Thinking Outside the Box!

Chlan

2016

American Journal of Critical Care

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Caring for critically ill patients receiving mechanical ventilation in the intensive care unit (ICU) is an immense challenge for clinicians. Interventions to maintain physiological stability and life itself can cause a number of adverse effects that have a marked impact on patients beyond the period of critical illness or injury. These ICU-acquired conditions include but are not limited to weakness, depression, and post–intensive care syndrome, all of which markedly affect patients’ quality of life after they leave the unit. How best to manage the many symptoms experienced by patients undergoing mechanical ventilation without contributing to adverse ICU-acquired sequelae remains a daunting charge for clinicians and requires innovative “out of the box” approaches to address these complex issues. Systematic, cutting-edge research is needed to challenge the “usual” way of managing ICU patients in order to provide the best available evidence for practice integration that minimizes adverse, ICU-acquired sequelae and improves outcomes for the most vulnerable patients. This article highlights a program of research focused on interventions for managing symptoms in critically ill patients receiving mechanical ventilatory support, including the appropriate empowerment of symptom self-management by patients undergoing mechanical ventilation. Development and testing of innovative, nontraditional interventions specifically tailored for ICU patients receiving mechanical ventilatory support are presented. Music listening is highlighted as a nonpharmacological, adjunctive intervention to reduce anxiety associated with mechanical ventilation. Patient-controlled sedation is discussed as an alternative method to meet patients’ highly individual needs for sedative therapy to promote comfort.

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A Randomized, Double-Blind Pilot Study of Dexmedetomidine Versus Midazolam for Intensive Care Unit Sedation

Cited by 39 publications

References 32 publications

Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis

Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Engaging Critically Ill Patients in Symptom Management: Thinking Outside the Box!

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