Source:Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial.
–499; doi:10.1001/jama.2009.56

The authors of this multinational, randomized, double-blinded trial compared the safety and efficacy of continuous dexmedetomidine to midazolam for sedation in mechanically ventilated adults. Enrolled patients were intubated and mechanically ventilated for less than 96 hours prior to start of study drug, and had an anticipated ventilation and sedation duration of at least three more days. Exclusion criteria were extensive and included pregnancy, severe brain pathology, acute liver failure, dialysis dependence, ischemic heart disease or cardiomyopathy, and those with persistent shock.

Sedation was managed using a nurse-implemented algorithm including daily drug interruption to target a light sedation goal. The Richmond Agitation-Sedation Scale1 (RASS) was used with a target score from −2 to 1. This is a score widely used in...

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