The latest study to be published in the Feb. 4 issue of the Journal of the American Medical reveals, dexmedetomidine induces sedation and anxiolysis via receptors in the locus ceruleus, analgesia via receptors in the spinal cord, and attenuation of the stress response without significant respiratory depression
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Investigators found that the results of the Safety and Efficacy of Dexmedetomidine with Midazola (SEDCOM) study show that dexmedetomidine-treated patients spent less time on the ventilator, experienced less delirium, and developed less tachycardiadefine and hypertension than those receiving midazolam.
"We hypothesized that a sedation strategy using dexmedetomidine would result in improved outcomes in mechanically ventilated, critically ill medical and surgical ICU patients compared with the standard GABA agonist midazolam," the investigators said.
“Despite the well-known hazards associated with prolonged use of GABA agonists,” the sedation guidelines have, for long, supported the efficacy of gamma-aminobuyyric-acid (GABA)-receptor agonists, including propofol and benzodiazepines such as midazolam, for sedation of critically ill patients in ICU, said principal investigator Richard R. Riker, MD, of the University of Vermont Medical Center and director of Critical Care Research at Maine Medical Center in Portland.
The study involved 376 medical/surgical ICU patients who required mechanical ventilationdefine for more than 24 hours. The records were collected from 68 medical centers in 5 countries.
“There was no difference in percentage of time within the target RASS range” between the 2 groups, Dr. Riker stated. There was, however, a statistically significant difference in the number of days on mechanical ventilation, with time to extubation almost 2 full days shorter [with dexmedetomidine],” he told Medscape Critical Care Medicine after his presentation.
Based on the randomized multinational, comparator Phase IV trial conducted from March 2005 through August 2007, the study revealed that prevalence of delirium in Precedex-treated patients was 22.6 percent less than those on midazolam.
"In addition to the medication administration protocol and incorporation of best sedation practices, the choice of medication used to provide sedation for ICU patients is a fundamental component of efforts to deliver safe and effective care," study authors quoted.
Median time for removing mechanical ventilation was 3.7 days in the Precedex-treated patients as against 5.6 days in the midazolam-treated patients, a difference of 44 hours. Although Precedex-treated patients were more likely to develop bradycardia, or slow heartbeat, but had a fewer chances of tachycardia (fast heartbeat) or hypertension that required treatment.
Richard R. Riker, M.D. further elaborated, “This multicenter study is one of the largest to compare two different sedatives for use in the ICU in a randomized and blinded design. Patients who received Precedex were extubated sooner and had a lower prevalence of delirium. I expect that patients requiring long-term sedation, their families and healthcare providers will welcome the results of this trial.”
Currently, there are nearly 5 million patients receiving treatment in the ICU (1).
“Through this clinical research for Precedex, Hospira is working to provide nurses, physicians and pharmacists with data to support a potential new sedation strategy for management of these complex and critically ill patients,” said Paula Bokesch, M.D., global medical director, Global Medical Affairs - Drug Development, Hospira.
“Hospira is committed to the research and development of products that improve patient care,” she said.
Almost every patient in the intensive care unit (ICU) requires sedation for his safety and comfort, and practice guidelines for sedation for those in ICU have identified the need for well-designed randomized trials comparing the effectiveness of different sedative agents for important clinical outcomes.
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