What is the role of dexmedetomidine (Precedex) in ICU sedation?

Updated: Nov 06, 2018
  • Author: Arul M Lingappan, MD; Chief Editor: Erik D Schraga, MD  more...
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Answer

ICU sedation

Dexmedetomidine is indicated for sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting by continuous IV infusion for up to 24 hours. It has been continuously infused in mechanically ventilated patients prior to extubation, during extubation, and post-extubation. It is not necessary to discontinue dexmedetomidine prior to extubation.In the randomized, double-blind, multicentre MIDEX and PRODEX trials that studied ICU patients receiving prolonged mechanical ventilation, dexmedetomidine was not inferior to midazolam and propofol in maintaining light to moderate sedation. Dexmedetomidine reduced duration of mechanical ventilation compared with midazolam and improved patients' ability to communicate pain compared with midazolam and propofol. Patients receiving dexmedetomidine had a higher incidence of hypotension and bradycardia compared with midazolam (20.6% vs 11.6% and 14.2% vs 5.2% respectively). [5]

Clinical practice guidelines by the Society for Critical Care Medicine that include recommendations on sedation in adult patients in the ICU urge the use of light sedation (vs deep sedation) in critically ill, mechanically ventilated adults. The guidelines also recommend the use of either propofol or dexmedetomidine over benzodiazepines for sedation in critically ill, mechanically ventilated adults. [25]


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