NIHR Signal: A newer sedative agent may shorten length of stay in intensive care units

National Institute for Health Research Signal

Cruickshank M, Henderson L, MacLennan G, Fraser C, Campbell M, Blackwood B, Gordon A, Brazzelli M.  Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review.  Health Technology Assessment Volume 20 Issue 25 , 2016

Adults needing mechanical ventilation who were sedated with dexmedetomidine had reduced length of stay in intensive care and reduced duration of ventilation.

Various sedative drugs are available for use in England although it is unclear if one is better than the others. This review compared two alpha-2 agonist drugs (clonidine and dexmedetomidine) to other commonly used sedative drugs: propofol and the benzodiazepines midazolam and lorazepam for adults on mechanical ventilation.

A 2014 survey reported that, while clonidine is used in about a third of units, dexmedetomidine is not frequently used. The latter drug is expensive, and this review did not consider cost-effectiveness which will be an important factor if the drug is to be used more widely.

This review’s findings on dexmedetomidine support best practice guidelines which suggest modest benefits for non-benzodiazepines compared to benzodiazepines.

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