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June 27, 2012

Medications for Sedation in Patients With Prolonged Mechanical Ventilation

JAMA. 2012;307(24):2587-2589. doi:10.1001/jama.2012.5972

To the Editor: In the 2 randomized controlled trials by Dr Jakob and colleagues,1 the authors concluded that among intensive care unit (ICU) patients receiving prolonged mechanical ventilation, dexmedetomidine was noninferior to midazolam and propofol in maintaining light to moderate sedation. In their trials, the target sedation Richmond Agitation-Sedation Scale (RASS) scores ranged from 0 to −3. However, we noticed that during sedation maintenance, patients receiving dexmedetomidine had higher actual RASS scores than those receiving midazolam or propofol. That is, those receiving midazolam or propofol compared with dexmedetomidine were at a deeper sedation level. In the absence of a comparable sedation level of medications between groups, the secondary outcome findings, such as nurses' assessment of arousal, patients' ability to cooperate with care, and patients' ability to communicate pain, should be interpreted with caution.