Dexmedetomidine and Propofol Show Similar Benefits in Adults on Mechanical Ventilation

By Gene Emery

February 04, 2021

NEW YORK (Reuters Health) - A comparison of dexmedetomidine and propofol finds that the two drugs produce very similar outcomes when used for light sedation in adults receiving mechanical ventilation despite some previous research suggesting that dexmedetomidine was the superior choice.

The number of days alive without delirium or coma, ventilator-free days, death at 90 days and scores on a cognitive test conducted six months after ventilation were not significantly different in the 214 given dexmedetomidine and the 208 who got propofol by random allocation.

All were being treated for sepsis.

"If we are doing up-to-date intensive-care unit (ICU) care and up-to-date sedation strategies, these two sedatives are equally effective when it comes to brain function, ventilation times and death," chief author Dr. Christopher Hughes, a professor of anesthesiology at Vanderbilt Medical Center in Nashville, Tennessee, told Reuters Health by phone.

He said the findings are particularly relevant to the pandemic because many people are on ventilators "and we are seeing a lot of brain function and sedation challenges with COVID."

But even before COVID-19, at least 4 million people each year find themselves on a ventilator after developing sepsis.

The results of the randomized blinded $5-million study, conducted at 13 U.S. medical centers and known as MENDS2, appear in the New England Journal of Medicine and were also presented at the virtual Society of Critical Care Medicine's Critical Care Congress.

Earlier research had suggested that dexmedetomidine might be a better choice with a lower risk of death, infection and time on a ventilator. But the findings haven't always been consistent.

"Our hypothesis was that dexmedetomidine would improve outcomes, so we were surprised because that's not what we thought we were going to find," Dr. Hughes said.

The patients were on the assigned sedation for a median of 3.0 days in the dexmedetomidine group and 4.0 days in the propofol group. Median scores on the Richmond Agitation-Sedation Scale (RASS) were virtually identical: -2.00 and -1.95 respectively.

In the primary outcome, which was the number of days alive without delirium or coma during a 14-day intervention period, the adjusted median was 10.7 days with dexmedetomidine and 10.8 days with propofol.

Among the secondary outcomes, the scores for dexmedetomidine and propofol were 23.7 days and 24.0 days respectively when it came to the number of ventilator-free days, 38% and 39% for the rates of death at 90 days, and 40.9 and 41.4 on the 101-point Telephone Interview for Cognitive Status questionnaire, which was administered at six months. The median age of the patients was 60.

Although there are theoretical benefits to using dexmedetomidine and other research supports a preference for its use, "the choice between dexmedetomidine and propofol alone does not appear to substantially affect patient outcomes in the complex milieu of critical illness with sepsis," the researchers conclude.

"Our findings, therefore, strongly reinforce current guidelines that recommend the use of either dexmedetomidine or propofol for light sedation when continuous sedation is needed for adults with or without sepsis who require mechanical ventilation," they write.

The study was funded by the National Institutes of Health.

SOURCE: The New England Journal of Medicine, online February 2, 2021.


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