To the Editor The trial by Dr Kawazoe and colleagues1 found no significant differences in ventilator-free days and mortality rates after 28 days among patients with sepsis receiving mechanical ventilation who did or did not receive dexmedetomidine, in contrast to previous randomized clinical trials2,3 and systematic reviews.4 The beneficial effects of dexmedetomidine in these studies suggest additional positive effects of α2-antagonists in sepsis due to its sympatholytic effects, limiting adrenergic stress as has been described for β-blocker treatment.5 Consequently, other explanations for the findings of Kawazoe and colleagues should be sought. There are several limitations of the present study that should be discussed.
Scheer CS, Kuhn S, Rehberg S. Dexmedetomidine in Patients With Sepsis Requiring Mechanical Ventilation. JAMA. 2017;318(5):479–480. doi:10.1001/jama.2017.7853