Sedation, analgesia & delirium · Choice of sedative
Dexmedetomidine- or Clonidine-Based Sedation Compared With Propofol in Critically Ill Patients
| Design | Phase 3 randomised clinical trial |
|---|---|
| Treatment | Dexmedetomidine-based or clonidine-based sedation |
| Control | Propofol-based sedation |
| Population | 1404 analysed critically ill patients, mean age 59.2, 64% male, mean APACHE II 20.3 |
| Follow-up | 180 days |
| Primary endpoint | Time to successful extubation |
| Result | The subdistribution hazard ratio for time to successful extubation was 1.09 with the alpha-2 agonist strategies compared with propofol, without meaningful benefit. Mortality over 180 days was similar to propofol for both dexmedetomidine (hazard ratio 0.98, 95% CI 0.77 to 1.24) and clonidine (1.04, 0.82 to 1.31). |
| Secondary endpoints | Delirium, mortality, adverse events, cost |
In critically ill patients, neither dexmedetomidine nor clonidine was superior to propofol in reducing time to successful extubation.
The trial authors, in the published abstract
Adds clonidine, a far cheaper alpha-2 agonist, to the comparison and reaches the same place as SPICE III and MENDS2. Three large trials, three neutral results: sedative choice is a matter of cost and side effects, not outcome.
Walsh TS, Parker RA, Aitken LM, et al. Dexmedetomidine- or Clonidine-Based Sedation Compared With Propofol in Critically Ill Patients: The A2B Randomized Clinical Trial. JAMA 2025 Jul 1;334(1):32-45.