107 / 242
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DEXMEDETOMIDINE. A SUMMARY
8
to two weeks. The researchers found no significant difference between both groups in the
achieved RASS score (between +1 and -2), length of stay on the ICU, and 30-day mortality. In
contrast, the incidence of delirium in the dexmedetomidine group was 54%, and compared
with 77% in the midazolam treated patients significantly lower.
The number of tachycardic and hypertensive episodes decreased during treatment with
dexmedetomidine, however with increased number of bradycardic events.
An open-label study of Maldonado et al.
8
showed a significant decrease in the incidence
of post-operative delirium in ICU patients after heart valve surgery. Patients sedated
with propofol or midazolam showed in 50% a delirium compared with 3% in the
dexmedetomidine group. This can be explained either due to the specific sedation profile
of dexmedetomidine or its characteristic to enable the reduction of other drugs that can
potentially trigger delirium. In the MENDS
9
trial, 106 intubated and ventilated patients were
sedated with dexmedetomidine or lorazepam. Patients in the dexmedetomidine group
had significantly more days without delirium or coma than those in the lorazepam group.
Coma was defined as a RASS of -4 or-5 (Table 2). In addition, the total percentage of the
time with an adequate RASS was higher in the dexmedetomidine group. To treat pain, both
groups could be given fentanyl. The incidence of fentanyl injections was significantly lower
in the lorazepam group. The authors discuss as a possible explanation that patients sedated
with dexmedetomidine can specify pain more appropriately. Important to know: both trials
(SEDCOM and MENDS) were sponsored by industry.
Table 2.
Richmond Agitation and Sedation Scale (RASS)
Score Rating
Description
+4
Combative
Violent, immediate danger to self and staff
+3
Very agitated
Aggressive, removes devices, tubes, catheters
+2
Agitated
Ventilator dys-synchrony, frequent non-purposeful movement
+1
Restless
Anxious but no aggressive movements
0
Alert and calm
−1
Drowsy
Sustained eye opening and eye contact to voice (> 10 s) but not fully alert
−2
Light sedation
Brief eye opening and eye contact to voice (< 10 s)
−3
Moderate sedation Movement or eye opening to voice but no eye contact
−4
Deep sedation
No response to voice, but movement or eye opening in response to physical
stimulation
−5
Un-arousable
No response to voice or physical stimulation