Sedation, analgesia & delirium · Choice of sedative
Dexmedetomidine vs midazolam for sedation of critically ill patients
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Dexmedetomidine |
| Control | Midazolam |
| Population | 375 mechanically ventilated ICU patients |
| Follow-up | 30 days |
| Primary endpoint | Percentage of time within the target Richmond Agitation-Sedation Scale range |
| Result | Time within target sedation range was 77.3% with dexmedetomidine versus 75.1% with midazolam (difference 2.2%, 95% CI -3.2% to 7.5%, p=0.18). At comparable sedation levels, dexmedetomidine-treated patients spent less time on the ventilator and experienced less delirium. |
| Secondary endpoints | Delirium prevalence, duration of ventilation, adverse events |
There was no difference between dexmedetomidine and midazolam in time at targeted sedation level in mechanically ventilated ICU patients. At comparable sedation levels, dexmedetomidine-treated patients spent less time on the ventilator, experienced less delirium.
The trial authors, in the published abstract
The trial that made benzodiazepines the sedative of last resort. Note the comparator: dexmedetomidine beats midazolam, and later trials show it does not beat propofol (SPICE III, MENDS2, A2B). What was really established was that benzodiazepines are the problem.
Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 2009 Feb 4;301(5):489-99.