SPICE 3

2019 Sedation and Delirium

? ICUs

4000 patients

Dexmed as primary sedative vs usual care effect 90 day mortality

Clinical Question

In ventilated, critically ill patients, does the use of dexmedetomidine as the primary sedative agent compared with usual sedative agents effect 90 day mortality?

Critical Appraisal

Key findings

No diff 90d mort. improved (24 vs 23 d) coma free, improved (23 vs 22d) ventilator free

Strengths

Important clinical question

Weaknesses

Outcome biologically implausible

Critique

primary outcome – it would seem biologically implausible that the use of dexmedetomidine could possibly reduce day-90 death by 4.4%

Population: Adult ICU Patients
Population Details: Requiring mechanical ventilation
Intervention Arms: Dexmedetomidine infusion (1 - 1.5 µg/kg/hr)
Dexmedetomidine infusion 1 to 1.5µg/kg/hr
Control Arms: Standard Care
Primary Outcome: 90 day mortality
Secondary Outcomes: Less mechanically ventilated days , More bradycardia
P Value: 0.98

Outcome Results

Not recorded

Primary location: Worldwide ANZICS Landmark trial