Sedation, analgesia & delirium · Choice of sedative
Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis
| Design | Multicentre, double-blind randomised controlled trial |
|---|---|
| Treatment | Dexmedetomidine, median dose 0.27 µg/kg/hour |
| Control | Propofol |
| Population | 422 analysed mechanically ventilated adults with sepsis, all managed with light-sedation targets |
| Follow-up | 90 days |
| Primary endpoint | Days alive without delirium or coma during the 14-day intervention period |
| Result | 214 patients received dexmedetomidine and 208 propofol. Outcomes did not differ between the two agents. |
| Secondary endpoints | Ventilator-free days, 90-day mortality, cognitive function at 6 months |
Among mechanically ventilated adults with sepsis who were being treated with recommended light-sedation approaches, outcomes in patients who received dexmedetomidine did not differ from outcomes in those who received propofol.
The trial authors, in the published abstract
The qualifier in the authors' own conclusion carries the meaning: when light sedation is achieved, the drug used to achieve it stops mattering. Consistent with SPICE III and A2B.
Hughes CG, Mailloux PT, Devlin JW, et al. Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis. N Engl J Med 2021 Apr 15;384(15):1424-1436.