Sedation, analgesia & delirium · Choice of sedative
Early Sedation with Dexmedetomidine in Critically Ill Patients
| Design | International multicentre randomised controlled trial |
|---|---|
| Treatment | Early dexmedetomidine as the primary sedative |
| Control | Usual care sedation |
| Population | 3904 analysed patients undergoing mechanical ventilation, randomised a median 4.6 hours after eligibility |
| Follow-up | 90 days |
| Primary endpoint | All-cause mortality at 90 days |
| Result | Death at 90 days occurred in 566 of 1948 (29.1%) in the dexmedetomidine group, similar to usual care. Patients receiving dexmedetomidine required supplemental sedatives to achieve the prescribed sedation level. |
| Secondary endpoints | Ventilator-free days, delirium-free days, coma-free days, adverse events |
Among patients undergoing mechanical ventilation in the ICU, those who received early dexmedetomidine for sedation had a rate of death at 90 days similar to that in the usual-care group and required supplemental sedatives to achieve the prescribed level of sedation.
The trial authors, in the published abstract
The largest sedation trial ever run, and decisively neutral. Together with MENDS2 and A2B, the modern position is that sedative choice matters far less than sedation depth — the lesson SLEAP taught from a different direction.
Shehabi Y, Howe BD, Bellomo R, et al. Early Sedation with Dexmedetomidine in Critically Ill Patients. N Engl J Med 2019 Jun 27;380(26):2506-2517.