Newer Sedative May Reduce Delirium in ICU Patients
MONDAY Feb. 2, 2009 -- The sedative dexmedetomidine (Precedex) reduces the time patients stay on ventilators and results in less delirium than other more commonly used drugs for patients in intensive care units, a new study finds.
For patients in ICUs, delirium is a common side effect of being sedated for an extended period; it can affect as many as 85 percent of ICU patients. Some of these patients can have lingering mental problems when they leave the hospital, problems that may last for as long as six months, experts say.
"While dexmedetomidine provided a similar amount of time at the target level of sedation as midazolam [Versed], there were significant outcome improvements in other aspects of care," said lead researcher Dr. Richard R. Riker, director of critical care research at Maine Medical Center, in Portland.
"They came off the ventilator nearly two days faster, they had a much lower incidence of delirium, and they had a lower incidence of infection," he added.
The report was expected to be published in the Feb. 4 issue of the Journal of the American Medical Association. It is being released early to coincide with a presentation of the finding at the Society of Critical Care Medicine annual meeting, in Nashville, Tenn.
For the study, Riker's team randomly assigned 375 patients being treated in the ICU to dexmedetomidine or the more commonly used sedative midazolam. The trial ran from March 2005 to August 2007, and included patients from 68 medical centers in five countries.
Among patients receiving dexmedetomidine, 54 percent experienced delirium, compared with 76.6 percent of those receiving midazolam. In addition, patients receiving dexmedetomidine had more delirium-free days than patients receiving midazolam (2.5 days vs. 1.7 days), the researchers found.
Moreover, patients receiving dexmedetomidine spent less time on ventilators than patients receiving midazolam. Patients receiving midazolam remained on ventilators almost two days longer than those receiving dexmedetomidine (5.6 days vs. 3.7 days), Riker's group reports.
Patients receiving dexmedetomidine were more likely to experience a slow heartbeat, but were less likely to experience a rapid heartbeat or high blood pressure than those receiving midazolam, the researchers noted.
The reasons for these results are varied and not well-understood, Riker said. The drugs target different parts of the brain, which may account for some of the differences, he added.
Riker thinks this study provides evidence that will get more physicians to use dexmedetomidine. "As we get more studies, I think it may potentially become a new standard of care," he noted.
However, Dr. John P. Kress, an assistant professor of medicine at the University of Chicago and co-author of an accompanying journal editorial, thinks dexmedetomidine may be appropriate for some patients, but it won't replace other drugs.
"Dexmedetomidine is one of many drugs that are out there as options," Kress said. "Do I think it should be used for everybody? No. Do I think it has the potential for more than a rare occasional patient? I think this study shows that that's the case. Will it replace the other drugs? I don't think it will."
Kress would also like to see a study of dexmedetomidine that could determine whether the drug improves long-term outcomes.
For more information on critical care, visit the U.S. National Library of Medicine.
Posted: February 2009