Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation*

Corbett, Stephanie Mallow; Rebuck, Jill A.; Greene, Christopher; Callas, Peter W.; Neale, Bruce W; Healey, Mark A.; Leavitt, Bruce J.

doi:10.1097/01.ccm.0000162565.18193.e5

Cited by 131 publications

(145 citation statements)

References 26 publications

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“…) than in most previous studies [10][11][12]. A need for additional sedatives has been reported with dexmedetomidine at doses of up to 2.5 lg kg -1 h -1 [13].…”

Section: Discussionmentioning

confidence: 71%

“…Dexmedetomidine was associated with less coma (defined as RASS -4 to -5) and markedly increased fentanyl needs in patients with RASS target -3 or deeper [14]. When viewed together with its short-term use [6,10,11] and any long-term use [12][13][14], our results suggest that dexmedetomidine should be further assessed for mild to moderate sedation rather than as sole sedative for deep sedation. Use of sedation protocols with daily sedation stops and sedation scores has been able to reduce the duration of mechanical ventilation and intensive care [1,2].…”

Section: Discussionmentioning

confidence: 91%

“…Dexmedetomidine has been studied in the ICU mainly for sedation after surgery up to 24 h [6,10,11]. Data from small uncontrolled studies suggest that dexmedetomidine may be safe and effective for long-term sedation as well [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation

et al. 2008

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Purpose: To compare dexmedetomidine (DEX) with standard care (SC, either propofol or midazolam) for long-term sedation in terms of maintaining target sedation and length of intensive care unit (ICU) stay. Methods: A pilot, phase III, double-blind multicenter study in randomized medical and surgical patients (n = 85) within the first 72 h of ICU stay with an expected ICU stay of C48 h and sedation need for C24 h after randomization. Patients were assigned to either DEX (B1.4 lg kg -1 h -1; n = 41) or SC (n = 44), with daily sedation stops.Results: Non-inferiority of DEX versus SC was not confirmed. Target Richmond agitation-sedation score (RASS) was reached a median of 64% (DEX) and 63% (SC) of the sedation time (ns). The length of ICU stay was similar in DEX and SC. Patients with RASS target 0-3 (DEX 78%, SC 80%) were at target sedation 74% (DEX) and 64% (SC) of the time (ns), whereas those with RASS target -4 or less reached the target 42% (DEX) and 62% (SC) of the time (P = .006). Post hoc analyses suggested shorter duration of mechanical ventilation for DEX (P = 0.025). Conclusions: This pilot study suggests that in long-term sedation, DEX is comparable to SC in maintaining sedation targets of RASS 0 to -3 but not suitable for deep sedation (RASS -4 or less). DEX had no effect on length of ICU stay. Its effects on other relevant clinical outcomes, such as duration of mechanical ventilation, should be tested further.

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“…) than in most previous studies [10][11][12]. A need for additional sedatives has been reported with dexmedetomidine at doses of up to 2.5 lg kg -1 h -1 [13].…”

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 91%

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Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation

et al. 2008

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“…One study was available to inform the hypothesis; in 89 surgical ICU patients receiving mechanical ventilation, propofol and dexmedetomidine provided equivalent amnesia and pain control, but dexmedetomidine led to greater discomfort and sleeping difficulties [30]. The present study compared patient comfort among sedatives using MMTA.…”

Section: Original Researchmentioning

confidence: 93%

Illustrating idiographic methods for translation research: moderation effects, natural clinical experiments, and complex treatment-by-subgroup interactions

Ridenour

Raiff

Benedict

et al. 2015

Behav. Med. Pract. Policy Res.

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A critical juncture in translation research involves the preliminary studies of intervention tools, provider training programs, policies, and other mechanisms used to leverage knowledge garnered at one translation stage into another stage. Potentially useful for such studies are rigorous techniques for conducting within-subject clinical trials, which have advanced incrementally over the last decade. However, these methods have largely not been utilized within prevention or translation contexts. The purpose of this manuscript is to demonstrate the flexibility, wide applicability, and rigor of idiographic clinical trials for preliminary testing of intervention mechanisms. Specifically demonstrated are novel uses of state-space modeling for testing intervention mechanisms of short-term outcomes, identifying heterogeneity in and moderation of within-person treatment mechanisms, a horizontal line plot to refine sampling design during the course of a clinic-based experimental study, and the need to test a treatment's efficacy as treatment is administered along with (e.g., traditional 12-month outcomes).

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“…Similar findings were referred to in a metaanalysis by Lynn and others [39] analysing the safety and efficiency of dexmedetomidine with post-operative cardio-surgical patients. Numerous studies comparing dexmedetomidine to propofol [40,41], midazolam [40,42,43], and morphine [44] confirmed that dexmedetomidine reduces the risk of delirium, agitation and/or confusion in critical ICU patients. This medicine is not yet registered in Serbia.…”

Section: Discussionmentioning

confidence: 99%

The importance of early recognition and timely treatment of delirium in intensive care units

Stašević-Karličić¹,

Stasevic²,

Djordjević³

et al. 2016

Praxis Med

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Delirium is connected to bad short-term (the increase in hospital mortality rate and hospital days) and long-term outcomes (disfunctionality, institutionalisation, cognitive damage and post hospital-release dementia). The objective of this study is to determine whether there are possible incompatibilities of treatment of delirium with the recommendations in the guides of good clinical practice from developed countries. The grounded method was used in the study. The so called principal sampling of 17 psychiatrists, anesthesiologists and registered nurses was conducted. Afterwards, the unstructured interviews with the selectees were conducted, transcribed and analyzed immediately through coding, category and concept detection. Having completed this, the theoretical sampling of new interview examinees was conducted. Their analysis enabled the concepts to be linked into a working theory and graphically displayed. The new sampling, the new interviews and their analysis were then continued interactively until the saturation of the working theory was achieved and the final version of the theory was formulated based on the findings reached through the interviews. Having completed the principal sampling and coding of the transcripts led the researches to the saturation of the theory through the separation of eight categories: A -Delirium as a sign of system infection, B -Therapy -Anaesthesiologists administer benzodiazepines, whereas psychiatrists administer antipsychotics, C -An inconspicuous onset of delirium is overlooked, D -Bleeding as the cause of delirium, E -Anticholinergics as a cause of delirium, F -Misunderstanding the nature of delirium by anaesthesiologists, G -Being aware that the patient is vitally endangered, and H -The nurses apply enhanced health care measures. Delirium is a syndrome which can be prevented in 30-40% of cases (50). An etiological treatment would help avoid complicating delirium's clinical picture and would very much prevent poor outcomes, such as institutionalisation, cognitive damage and delirious patients' high mortality rate.

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Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation*

Cited by 131 publications

References 26 publications

Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation

Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation

Illustrating idiographic methods for translation research: moderation effects, natural clinical experiments, and complex treatment-by-subgroup interactions

The importance of early recognition and timely treatment of delirium in intensive care units

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