JOURNAL CLUB. Sequential use of midazolam and dexmedetomidine for long-term sedation may reduce weaning time in selected critically ill, mechanically ventilated patients: a RCT
By: Marcelo Alcantara, Médico - 05/12/2022 18:53
Zhou, Y. et al. Sequential use of midazolam and dexmedetomidine for long-term sedation may reduce weaning time in selected critically ill, mechanically ventilated patients: a randomized controlled study. Crit Care 26, 122 (2022).
In this interesting single-center RCT study, the authors enrolled critically ill, mechanically ventilated adult patients receiving midazolam with anticipated mechanical ventilation for ≥ 72 h.
During the weaning phase, patients were randomized into group M-D (midazolam was switched to dexmedetomidine), group M-P (midazolam was changed to propofol), and group M (sedation with midazolam alone), and sedatives were titrated to achieve the targeted sedation range (RASS − 2 to 0).
Two hundred fifty-two (252) patients were enrolled.
Patients in group M-D had an earlier recovery, faster extubation, and more percentage of time at the target sedation level than those in group M-P and group M (all P < 0.001).
They also experienced less weaning time (25.0 h vs. 49.0 h; HR1.47, 95% CI 1.05 to 2.06; P = 0.025), and a lower incidence of delirium (19.5% vs. 43.8%, P = 0.002) than patients in group M.
Recovery (P < 0.001), extubation (P < 0.001), and weaning time (P = 0.048) in group M-P were shorter than in group M,
The acquisition cost of the sedative drug was more expensive than other groups (both P < 0.001).
We selected this paper for our Forum because the long-term sedation of mechanically ventilated patients is always a tough challenge in everyday practice in the ICU.
Although this work is a single-center trial, the findings are exciting and certainly point out the importance of the type of the sedative during the weaning phase, when sedation is still required.
What is your opinion on the paper?
Would it change anything in your practice concerning the clinical scenario addressed by the investigation?
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