Sedative medications used in intensive care are associated with increased delirium, which in itself is associated with higher medical costs and an increased risk of death and depression associated with ICU.
A study published today in the New England Journal of Medicine providing the most convincing evidence to date, of the two drugs recommended for mild sedation of patients undergoing mechanical ventilation in the ICU, one is as effective and safe as the other.
Mechanical ventilation is a life-saving intervention often involves a breathing tube inserted into the patient’s windpipe, usually involving mild sedation to eliminate the infection. -comfort, anxiety and associated psychological stress. Several studies have sought evidence of which sedative is best for this purpose. Two current sedatives, dexmedetomidine or propofol are recommended.
The new study, a double-blind, randomized controlled trial at researchers at Vanderbilt University Medical Center, recorded 422 adults with mechanical ventilation at 13 U.S. medical centers. As patients were placed on ventilators, about half of them were lightly ignited with dexmedetomidine, the other half with propofol. All patients had sepsis, a dangerous and relapsing body infection.
“We found very similar patient outcomes with both drugs for brain function, shower times and death. From an emergency care outcomes perspective, our results show that both of these sedatives are equally effective when performed state-of-the-art ICU care, “said Christopher Hughes, MD, professor of anesthesiology, who led the study with Pratik Pandharipande, MD, MSCI, professor of anesthesiology.
- During the 14 days from the onset of mechanical ventilation, the median total days without delirium or coma were 10.7 in the dexmedetomidine group, 10.8 in the propofol group.
- During the 28 days from the start of cooling, the median days without cooling were 23.7 in the dexmedetomidine group, 24.0 in the propofol group.
- Death occurred within 90 days for 38% of those who received dexmedetomidine, and 39% of those who received propofol.
- The mean mental status score at six months was 40.9 in the dexmedetomidine group, 41.4 in the propofol group. (In all drug groups, at six months after the illness, approximately one in four patients appeared to present with a clinically significant mental disorder, with scores of two normal deviations below population levels.)
“For this emergency care application, statistically speaking, there is nothing in our results to differentiate the safety images and patient outcomes of these two drugs,” Pandharipande said.
Dexmedetomidine, which is a newer sedative drug, was expected to support better patient outcomes, because, compared to some other sedatives used in severely ill patients, it is known that it provides benefits such as better sleep and better anti-inflammatory properties. The new results, however, yield to less rigorous trials and did not find significant product benefits with the latest drug.
“Our conclusions […] strongly confirms conventional guidelines recommending either the use of dexmedetomidine or propofol for mild sedation when continuous sedation is required for adults requiring mechanical ventilation, with or without sepsis, ”the authors conclude. writing.
“This randomized multicenter clinical trial answers a clinically important question in critical care,” said Lora Reineck, MD, MS, program leader of the Lung Injury and Emergency Care program at the National Heart Institute, Lung and the Blood. “We now know that the choice of dexmedetomidine versus propofol does not alter outcomes for patients with sepsis on airways in an emergency care setting.”
Pandharipande and Hughes joined the study with 24 other researchers from VUMC and 38 researchers from other centers. The study was supported by a grant from the National Institutes of Health (HL111111).
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