💊💊Will tackle the literatures for one of the sedatives💉💉in the upcoming Friday thread. Please vote for your team 💪🏻
Thanks for voting. Dexmedetomidine team wins 🥳🥳🤑🤑. This Friday will review literatures regarding Dex use in critically ill patients. Stay tuned 🔥 🔥
🚨🚨warning: you might get dizzy, drowsy but communicative!! Grab your coffee and be ready for #dexmedetomidine thread.
There are certain points to keep in mind about Dex before reviewing the major trials about its use in critical care settings. What makes it different than other sedatives, its mechanism of action as alph2 agoinst, that’s why it has less respiratory depression risk.
Dex is the only sedative that can be used for sedation in non intubated patients. It allows patients to be communicative with the team. It provides light to moderate sedation so it might be not the best option for deep sedation.
It has reasonable side effects profile in some patients can cause hypotension/bradycardia with bolus doses or high infusion rate. Dex has been researched extensively in wide variety of indications sedation, analgesia, opioids sparing, delirium, agitation, Alcohol withdrawals..
Dex supporters always referring to its beneficial effects in reducing ICU length of stay, reducing delirium incidence/duration , opioids sparing effects and early extubation. Most of the studies that I’m going to review is either prove or dispute these outcomes.
MENDS,2007. Compared the sedation effect of dex vs. lorazepam smd whether it reduces delirium duration. Found patients on dex had more days alive without delirium or coma.
SEDCOM, 2009. Comparing efficacy and safety of dex vs. midazolam in mech vent patients. No diff in the sedation but dex gp has less delirium, more rapid extubation snd higher bradycardia and no diff in opioids use or LOS🤔🤔
PRODEX, MIDEX 2012. To determine thr efficacy of dex vs. propofol or midazolam in maintaining sedation, reducing mech vent duration snd improving patients interactions. Concluded that dex was not inferior to both agents in terms of maintaining light to moderate sedation..,cont
..dex reduces duration on mech vent compared to midazolam and improve patients communication in comparison to both agents!!
SPICE trial, 2019. To compare early sedation with dex vs. usual care in critically ill patients. Similar 90days mortality, same supplemental sedation requirements with more adverse effects in dex go🤢🤔
Meta analysis for all RCT (2014 in J cardiothorac Vasc Anesth.). To evaluate dex effects on delirium, agitation and confusing in ICU. Concluded that dex could help to reduce delirium in critically ill patients.
Other literatures regarding some of dex uses will be addressed late. I believe that even extensive research have been done on Dex still these studies suffer from limitations and been criticized in the practice. Evidence regarding dex still of low quality🙊
Lots of questions needs to be answered, is faster extubation an enough outcome or we should evaluate more long terms outcomes. Better patients communication needs to be assessed from patients perception. Cost is a huge point to consider among different countries!
Advice to stick to the latest PADIS guidelines recommendations regarding dex use in ICU settings. With DEX I have seen huge success with some patients and big failures with other patients. I guess I have more questions regarding this agent than answers???
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