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  • Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis: A Randomized Clinical Trial

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    JAMA. 2017; 317(13):1321-1328. doi: 10.1001/jama.2017.2088

    This randomized clinical trial compares the effects of sedation with vs without dexmedetomidine on mortality and ventilator-free days in patients with sepsis.

  • JAMA April 4, 2017

    Figure 2: 28-Day Mortality Among the Dexmedetomidine and Control Groups

    Day 1 is defined as the first day of randomization into the trial.
  • JAMA April 4, 2017

    Figure 3: Percentage of Patients With Well-Controlled Sedation and Delirium- and Coma-Free Days During ICU Stay Among the Dexmedetomidine and Control Groups

    To examine the effect of dexmedetomidine on sedation control and the occurrence of delirium and coma, a generalized linear model was used accounting for repeated measurements in the same patient. Well-controlled sedation was defined as a Richmond Agitation-Sedation Scale (RASS) score between −3 and +1 throughout 1 day spent in the intensive care unit (ICU) and was defined as (rate of controlled sedation) = (patient’s number of days with well-controlled sedation)/(total number of patients in the ICU), calculated for each day. Coma was defined as an RASS score between −4 and −5 throughout 1 day in the ICU. Day 1 is defined as the first day of randomization into the trial.
  • Effect of Dexmedetomidine Added to Standard Care on Ventilator-Free Time in Patients With Agitated Delirium: A Randomized Clinical Trial

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    JAMA. 2016; 315(14):1460-1468. doi: 10.1001/jama.2016.2707

    This randomized clinical trial assesses the effectiveness of dexmedetomidine when added to standard care in patients with agitated delirium receiving mechanical ventilation.

  • JAMA April 12, 2016

    Figure 1: Patient Flow Diagram of the DahLIA Trial

    The number of patients not randomized due to not meeting the inclusion criteria or having met 1 of the exclusion criteria was not recorded. DahLIA indicates Dexmedetomidine to Lessen ICU Agitation.aEstimated from total admission numbers to each intensive care unit along with data from the Australian and New Zealand Intensive Care Society Centre for Outcomes and Resource Evaluation on the proportion of these admissions that were intubated.
  • The Evolving Approach to Brain Dysfunction in Critically Ill Patients

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    JAMA. 2016; 315(14):1455-1456. doi: 10.1001/jama.2016.2708
  • Dexmedetomidine vs Midazolam or Propofol for Sedation During Prolonged Mechanical Ventilation: Two Randomized Controlled Trials

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    JAMA. 2012; 307(11):1151-1160. doi: 10.1001/jama.2012.304
  • JAMA March 21, 2012

    Figure 1: Flow Diagrams for the Dexmedetomidine vs Midazolam (MIDEX) and Dexmedetomidine vs Propofol (PRODEX) Trials

    For patients who did not meet inclusion criteria, and for each patient withdrawn from treatment after randomization, more than 1 reason could apply. Patients who withdrew their consent (1 in the midazolam group and 2 in the propofol group) denied any use of their data in the analyses.
  • JAMA March 21, 2012

    Figure 2: Duration of Mechanical Ventilation and Intensive Care Unit Stay

    In the MIDEX trial (midazolam vs dexmedetomidine), the median duration of mechanical ventilation was, for dexmedetomidine, 123 hours (interquartile range [IQR], 67-337 hours) and, for midazolam, 164 hours (IQR, 92-380 hours) (Gehan-Wilcoxon P = .03). The median length of stay in the intensive care unit (ICU) from randomization until the patient was medically fit for discharge was, for dexmedetomidine, 211 hours (IQR, 115-831 hours) and, for midazolam, 243 hours (IQR, 140-630 hours; Gehan-Wilcoxon P = .27). In the PRODEX trial (propofol vs dexmedetomidine), the median duration of mechanical ventilation was, for dexmedetomidine, 97 hours (IQR, 45-257 hours) and, for propofol, 118 hours (IQR, 48-327 hours) (Gehan-Wilcoxon P = .24). The median length of stay in the ICU from randomization until the patient was medically fit for discharge was, for dexmedetomidine, 164 hours (IQR, 90-480 hours) and, for propofol, 185 hours (93-520 hours; Cox's proportional hazards test P = .54). Study drugs were given for a maximum of 336 hours in both trials.
  • Weighing the Costs and Benefits of a Sedative

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    JAMA. 2012; 307(11):1195-1197. doi: 10.1001/jama.2012.319
  • Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients: A Randomized Trial

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    JAMA. 2009; 301(5):489-499. doi: 10.1001/jama.2009.56
  • JAMA February 4, 2009

    Figure 2: Daily Prevalence of Delirium Among Intubated Intensive Care Unit Patients Treated With Dexmedetomidine vs Midazolam

    Delirium was diagnosed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). At baseline, 60.3% of dexmedetomidine-treated patients and 59.3% of midazolam-treated patients were CAM-ICU–positive (P = .82). The effect of dexmedetomidine treatment was significant in the generalized estimating equation analysis, with a 24.9% decrease (95% confidence interval,16%-34%; P < .001) relative to midazolam treatment. Numbers differ from those for primary analysis because patients were extubated, discharged from the intensive care unit, or had missing delirium assessments.
  • JAMA February 4, 2009

    Figure 3: Time to Extubation and Intensive Care Unit (ICU) Length of Stay Among Patients Treated With Dexmedetomidine vs Midazolam

    A, Time to extubation was calculated from the start of study drug to the time of extubation after which no reintubation occurred. Patients not extubated were censored at time of study drug discontinuation. The median time to extubation was 1.9 days shorter for the dexmedetomidine group than for the midazolam group (3.7 days [95% confidence interval {CI}, 3.1-4.0] vs 5.6 days [95% CI, 4.6-5.9]; P = .01 by log-rank test). B, Length of ICU stay was calculated from start of study drug to time of order for ICU transfer. Patients without discharge were censored at the time of study drug discontinuation. The median length of ICU stay was similar between the dexmedetomidine and midazolam groups (5.9 days [95% CI, 5.7-7.0] vs 7.6 days [95% CI, 6.7-8.6]; P = .24 by log-rank test).
  • JAMA February 4, 2009

    Figure 1: Patient Enrollment, Randomization, and Treatment Flow

    Data were analyzed using the primary analysis population (n = 366) as well as the long-term use population (n = 297), the group specifically requested by the US Food and Drug Administration as a means of obtaining long-term efficacy and safety data for dexmedetomidine. RASS indicates Richmond Agitation-Sedation Scale.aInvestigator felt that patient no longer met entry criteria (eg, extubated, no longer required sedation, required deeper sedation).bPatient had new information after consent that identified an exclusion criterion (eg, need for general anesthesia, unexpected liver or cardiac disease).
  • Effect of Sedation With Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients: The MENDS Randomized Controlled Trial

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    JAMA. 2007; 298(22):2644-2653. doi: 10.1001/jama.298.22.2644
  • JAMA December 12, 2007

    Figure 4: Percentage of Patients by Study Day Who Were Within 1 Point of the RASS Sedation Goal While Receiving Study Drug

    Percentage of patients within 1 point of the nurse target (goal) Richmond Agitation-Sedation Scale (RASS) sedation score (physician data similar). On any given day, dexmedetomidine-treated patients had a 4% to 17% greater likelihood of being at the target sedation score than lorazepam-treated patients. Patients in the study were permitted to be administered the study drug for 120 hours (5 days). Some patients received the study drug until day 6, which reflects enrollment and start of study drug late on day 1 and required drug infusion until day 6, for completion of 120 hours of study drug use.
  • JAMA December 12, 2007

    Figure 5: Fentanyl Dose While Receiving Study Drug According to Depth of Target Sedation

    The median fentanyl dose was 575 μg/d in the dexmedetomidine group vs 150 μg/d in the lorazepam group (P = .006), and this difference in dosage was more notable when patients were more deeply sedated than when patients were lightly sedated. Deep sedation was defined as a Richmond Agitation-Sedation Scale (RASS) target score of −3 and deeper (−4 and −5); light sedation, as a Rass target score of −2 and lighter (−1, 0, etc). Patients were permitted to be administered the study drug for 120 hours.
  • Dexmedetomidine in Patients With Sepsis Requiring Mechanical Ventilation

    Abstract Full Text
    JAMA. 2017; 318(5):479-480. doi: 10.1001/jama.2017.7853
  • Dexmedetomidine in Patients With Sepsis Requiring Mechanical Ventilation—Reply

    Abstract Full Text
    JAMA. 2017; 318(5):480-480. doi: 10.1001/jama.2017.7869