Table 2.
Adherence and Sedation Regimen.
| Outcome | Dexmedetomidine N = 214 |
Propofol N = 208 |
|---|---|---|
| Median hours from meeting inclusion criteria to drug initiation (IQR) | 22.4 (13.4–31.3) | 22.1 (12.8–33.7) |
| Median hours from randomization to drug initiation (IQR) | 1.3 (0.9–2.2) | 1.3 (0.8–2.1) |
| Trial drug administration | ||
| Median days of receipt of drug (IQR) | 3.0 (2.0–5.0) | 4.0 (2.0–6.0) |
| Median days from first meeting trial criteria to initiation of drug (IQR) | 1.00 (0.00–1.00) | 1.00 (0.00–1.00) |
| Median daily volume on days administered (IQR) — ml | 119 (46–243) | 131 (67–229) |
| Median daily dose on days administered (IQR) | 0.27 μg/kg/hr (0.11–0.61) | 10.2 μg/kg/min (5.5–18.4) |
| Median total no. of drug adjustments per patient (IQR) | 9 (5–15.8) | 11.5 (5.8–25) |
| Drug temporarily held — no. (%)* | 60 (28) | 57 (27) |
| Median no. of times drug temporarily held per patient (IQR) | 1 (1–1) | 1 (1–2) |
| Drug permanently discontinued — no. (%) | 25 (12) | 23 (11) |
| Trial or clinical team aware of the drug used — no. (%) | 27 (13) | 31 (15) |
| Withdrawal from trial during hospitalization — no. (%) | 10 (5) | 9 (4) |
| Median RASS score while receiving drug (IQR) | −2.00 (−3.00 to −1.00) | −1.95 (−3.03 to −0.98) |
| Percent time at target sedation level while receiving drug | 57 | 60 |
| Median CPOT score while receiving drug (IQR)† | 0.33 (0.00–0.83) | 0.31 (0.00–0.87) |
| Percent of days with adherence to ABCDE bundle‡ | ||
| Spontaneous awakening trial | 98 | 98 |
| Spontaneous breathing trial | 93 | 95 |
| Coordination of awakening and breathing trials | 86 | 84 |
| Nondrug delirium interventions | 99 | 99 |
| Early mobilization | 91 | 92 |
| Median daily fentanyl dose on days administered (IQR) — μg/hr | 68 (28–119) | 56 (20–95) |
| Midazolam exposure | ||
| Ever used — no. (%) | 114 (53) | 90 (43) |
| Median days among users (IQR) | 2.0 (1.0–4.0) | 1.0 (1.0–2.0) |
| Median daily dose on days administered (IQR) — mg per day | 3.8 (2.0–10.9) | 4.0 (2.0–10.8) |
| Antipsychotic exposure | ||
| Ever used — no. (%) | 90 (42) | 87 (42) |
| Median days among users (IQR) | 5.0 (2.0–7.8) | 4.0 (2.0–8.0) |
| Median daily dose on days administered (IQR) — mg§ | 2.2 (1.0–6.4) | 3.6 (1.0–6.3) |
| Open-label propofol exposure | ||
| Ever used — no. (%) | 27 (13) | 16 (8) |
| Median days among users (IQR) | 2.0 (1.0–3.0) | 1.5 (1.0–2.0) |
| Median daily dose on days administered (IQR) — μg/kg/min | 10.8 (4.9–17.4) | 4.8 (3.4–6.6) |
| Open-label dexmedetomidine exposure | ||
| Ever used — no. (%) | 9 (4) | 6 (3) |
| Median days among users (IQR) | 1.0 (1.0–2.0) | 1.0 (1.0–3.2) |
| Median daily dose on days administered (IQR) — μg/kg/hr | 0.24 (0.04–0.30) | 0.26 (0.07–0.7) |
The reasons for temporary holding of the drug included oversedation, hypotension, or bradycardia; spontaneous awakening trials or times during which patients were not being sedated, were not receiving mechanical ventilation, or were in the operating room are not included.
The Critical Care Pain Observation Tool (CPOT) is used to assess for pain by evaluating facial expression, body movement, muscle tension, and adherence to use of the ventilator if intubated or vocalization if extubated. Total scores range from 0 to 8, with scores higher than 2 indicating the presence of pain.
The ABCDE bundle includes evaluations for awakening and breathing coordination, choice of sedation, delirium monitoring and management, and early mobility.
Values shown are in intravenous haloperidol equivalents.