No Mortality Benefit for Dexmedetomidine as a Sole Sedation Agent

Dexmedetomidine is an α-agonist that can be used for light sedation in the intensive care unit. In previous trials, requisite doses of benzodiazepines and propofol were lower among patients who received dexmedetomidine, and it is associated with lower rates of delirium (e.g., NEJM JW Gen Med Oct 15 2016 and Lancet 2016; 388:1893). As use of dexmedetomidine has grown, clinicians have been wondering whether it could be used as the sole sedating agent for critically ill patients.

Investigators in eight countries randomized 4000 patients who were receiving mechanical ventilation either to dexmedetomidine as primary sedation or to usual care. Most enrolled patients were receiving ventilation for respiratory disorders; a quarter were postoperative…