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June 27, 2012

Medications for Sedation in Patients With Prolonged Mechanical Ventilation—Reply

Author Affiliations

Author Affiliations: Department of Intensive Care Medicine, Bern University Hospital, Bern, Switzerland (Drs Takala and Jakob) (Jukka.takala@insel.ch); and Department of Anesthesiology and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland (Dr Ruokonen).

JAMA. 2012;307(24):2587-2589. doi:10.1001/jama.2012.5976

In Reply: Dr Xue and colleagues are concerned that the secondary outcome variables of nurses' assessment of arousal and patients' ability to cooperate and communicate pain should be interpreted with caution due to the lighter actual sedation level in dexmedetomidine vs midazolam and propofol groups. We agree that the lighter sedation should enhance communication. In addition, the different mode of action of dexmedetomidine may have contributed. Regardless of the mechanism, use of dexmedetomidine resulted in lighter actual sedation but still within the same target range and similar time at target range without rescue medication. This lighter sedation was considered clinically acceptable. We believe that this—and the improved communication—is an advantage, for whatever reason it may have occurred.