Question

In ventilated, critically ill patients, does the use of dexmedetomidine as the primary sedative agent compared with usual sedative agents effect 90 day mortality?

Methods

Multicentre international RCT

Answer

The use of dexmedetomidine as the primary or sole sedative in ventilated ICU patients did not result in lower 90-day mortality

Secondary outcomes

No difference in : death at 180 days, cognitive decline, quality of life

Small difference in: median days free from coma (24 vs 23) and ventilator-free days (23 vs 22)

Adverse events

More bradycardias, hypotensive episodes and episodes of asystole

Interpretation

Don’t use dexmedetomidine as a sole or primary sedative agent in ventilated ICU patients

Consider using it in agitated or delirious patients as a means to wean usual sedation