Comparison of dexmedetomidine and propofol in mechanically ventilated patients with sepsis: A pilot study

Objective: To compare the effects of a propofol-based versus dexmedetomidine-based sedation regimen for mechanically ventilated patients with sepsis. Methods: Single-center, randomized, open-label interventional study of critically ill patients admitted to the intensive care unit with sepsis and respiratory failure requiring mechanical ventilation. Patients were sedated with either propofol or dexmedetomidine. Results: Thirty-six patients with sepsis and respiratory failure requiring mechanical ventilation were randomly assigned to receive sedation with either dexmedetomidine or propofol. Fentanyl was used for analgesia in both groups. The primary end point was duration of mechanical ventilation, and secondary end points included 28-day mortality, the duration of ICU stay, and the duration of vasopressor support. There was a non-statistically significant trend toward decreased duration of mechanical ventilation in the dexmedetomidine group (p = 0.107), and multivariable analysis demonstrated a small to moderate effect size in the sample. There were no significant differences in 28-day mortality, duration of ICU stay, or duration of vasopressor requirement. No patients required discontinuation of study drug due to adverse effects. Conclusions: Although underpowered for statistical significance, there was a trend toward decreased duration of mechanical ventilation with dexmedetomidine. More studies with higher patient enrollment are needed to determine whether the duration of mechanical ventilation in patients with sepsis who receive sedation with dexmedetomidine is reduced when compared to propofol.