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April 2, 2008

Sedation With Dexmedetomidine vs Lorazepam in Mechanically Ventilated Patients

JAMA. 2008;299(13):1540-1542. doi:10.1001/jama.299.13.1541

To the Editor: In their randomized trial, Dr Pandharipande and colleagues1 concluded that sedation with an infusion of dexmedetomidine resulted in more days alive without delirium or coma and more time at the targeted level of sedation compared with an infusion of lorazepam. However, clinicians should not conclude that use of dexmedetomidine was associated with a decrease in the incidence of ICU delirium given that a combined delirium and coma end point was used to define acute brain dysfunction, and delirium-free days rather than the incidence of delirium at any time during ICU stay was reported. The incidence of delirium at any time in the ICU may be a better predictor of patient outcome than the number of hours that a patient spends in delirium.2

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