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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES & RELATED

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Thursday, April 15, 2021

Dexmedetomidine vs Propofol for Sedation

REBEL CRIT - April 15, 2021 - By Salim Rezaie
Paper: Hughes CG et al. Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis. NEJM 2021. PMID: 33528922
“Clinical Question: In adult patients with sepsis, acute respiratory failure, and requiring mechanical ventilation, is dexmedetomidine or propofol superior in reducing neurological dysfunction (i.e delirium or coma) during a 14 day intervention period?
Author Conclusion: “Among mechanically ventilated adults with sepsis who were being treated with recommended light-sedation approaches, outcomes in patients who received dexmedetomidine did not differ from outcomes in those who received propofol.”
Clinical Take Home Point: Among critically ill patients with sepsis who were receiving mechanical ventilation, it is not surprising that dexmedetomidine did not lead to better outcomes than propofol in any outcome. To me, it is unreasonable to expect low doses of dexmedetomidine and propofol (median dose 0.27ug/kg/hr and 10ug/kg/min) could achieve the intended RASS goals for light sedation. In fact, a lot of fentanyl and other rescue medications were used to keep patients sedated.”