MENDS2

Clinical Question

In mechanically ventilated adults with sepsis, does the use of dexmedetomidine, compared with propofol, for continuous sedation improve the number of days alive without delirium or coma?

Critical Appraisal

Key findings

Trial interventions (dexmedetomidine vs propofol):Median daily dose on days administered (IQR): 0.27 mcg/kg/hr (0.11-0.61) vs 10.2 mcg/kg/min (5.5-18.4)Trial or clinical team aware of the drug used: 13% vs 15%Withdrawal from trial during hospitalisation: 5% vs 4%Median RASS score while receiving drug (IQR): -2.00 (-3.00 to -1.00) vs
-1.95 (-3.03 to -0.98)Percent time at target sedation level while receiving drug: 57% vs 60%Percent of days with adherence to ABCDE bundle: Spontaneous awakening
trial: 98% vs 98% Spontaneous breathing trial: 93% vs 95% Coordination of
awakening and breathing trials: 86% vs 84% Non-drug delirium interventions:
99% vs 99% Early mobilisation: 91% vs 92% Median daily fentanyl dose on days administered (IQR): 68mcg/hr (28-119)
vs 56mcg/hr (20-95)Midazolam ever used: 53% vs 43%Median daily midazolam dose on days administered (IQR): 3.8mg/day
(2.0-10.9) vs 4.0mg/day (2.0-10.8)Antipsychotics ever used: 42% vs 42%Open-label propofol every used: 13% vs 8%Open-label dexmedetomidine ever used: 4% vs 3%

Critique

“Among critically ill adults with sepsis who were receiving mechanical
ventilation and for whom recommended light-sedation approaches were used,
dexmedetomidine did not lead to better outcomes than propofol with respect
to days alive without acute brain dysfunction, ventilator-free days, death
at 90 days, or cognition at 6 months.”

Outcome Results

Not recorded