Study compares ICU sedation drugs

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A recently published study revealed that patients who were mechanically ventilated and sedated in the ICU had a more favorable outcome when an initial continuous infusion of dexmedetomidine (Precedex) was used for sedation instead of midazolam (Versed). The U.S. Food and Drug Administration currently approves Dexmedetomidine, a selective alpha-2 agonist, for sedation in initially intubated and mechanically ventilated patients in the ICU for up to 24 hours. Available as 100 mcg/mL base in a 2 mL clear glass vial, dexmedetomidine must be diluted in 0.9% sodium chloride solution to achieve required concentration (4 mcg/mL) prior to administration. A loading infusion of 1 mcg/kg over 10 minutes, followed by a maintenance infusion of 0.2 to 0.7 mcg/kg/hr is typically required; however, the maintenance infusion can be adjusted to achieve the desired level of sedation.

The study took place in five countries and enrolled 375 medical/surgical ICU patients who were expected to require more than 24 hours of mechanical ventilation. The two drugs were compared for effectiveness, length of time of mechanical ventilation, and the incidence of delirium. Study findings revealed that patients treated with dexmedetomidine were sedated as effectively as those treated with midazolam. Patients treated with dexmedetomidine, however, were able to be weaned from mechanical ventilation almost two days earlier than those treated with midazolam. The incidence of delirium was also significantly lower: 22.6% less among patients treated with dexmedetomidine.

Weaning mechanically ventilated patients sooner and with less adverse events is desirable from both care provision and economic standpoints. The increased use of dexmedetomidine among mechanically ventilated patients not only reduces ICU stays but also can be part of a strategy to reduce ventilator-associated pneumonia.