FROM CHEST
The nonbenzodiazepines propofol and dexmedetomidine reduce the time to extubation, compared with benzodiazepines, suggest results of an observational study published in Chest.
“This study found that sedatives vary in their associations with [ventilator-associated events] and time to extubation but not in their associations with time to hospital discharge or mortality. Both propofol and dexmedetomidine were associated with less time to extubation, compared with benzodiazepines,” wrote Dr. Michael Klompas of the department of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, both in Boston, and colleagues ( Chest. 2016 Jun;149[6]:1373-9 ).
Current sedation guidelines for mechanical ventilation recommend using nonbenzodiazepines to lightly sedate patients, whenever possible.
Compared with the use of benzodiazepines, the uses of propofol and dexmedetomidine were associated with shorter times to extubation with hazard ratios of propofol vs. benzodiazepines and dexmedetomidine vs. benzodiazepines of 1.4 (P less than .0001) and 2.3 (P less than .0001), respectively. In the relatively few cases involving uses of dexmedetomidine that were available, this sedative was also associated with shorter time to extubation, compared with propofol (HR, 1.7; P less than .0001).
Uses of benzodiazepines and propofol were associated with increased risk for ventilator-associated events (VAEs), compared with regimens not involving them; for benzodiazepine use, the HR was 1.4 (P = .002) and for propofol, the HR was 1.3 (P = .003). Dexmedetomidine use, in contrast, was not associated with increased risk for VAEs (P = .92).
Regarding hazards for hospital discharges and hospital deaths, using each sedative or sedative class studied had similar outcomes.
The observational study involved 9,603 retrospectively identified mechanical ventilations. All consecutively occurring invasive mechanical ventilations lasting 3 days or longer in Boston’s Brigham and Women’s Hospital between July 1, 2006 and December 31, 2013 were studied. The researchers evaluated the impact that daily use of propofol, dexmedetomidine, and benzodiazepines have on VAEs, time to extubation, time to hospital discharge, and death in a large cohort of patients.
This study’s findings were similar to those of prior randomized controlled trials, especially concerning the time to extubation, the researchers said. “The large number of episodes of mechanical ventilation in our trial dataset, however, allowed us to extend conceivable but underpowered signals from randomized controlled trials.”
A limitation of this study is that it was a single-center retrospective analysis, which may have caused some of its findings to be attributable to “residual confounding and/or idiosyncratic local practice patterns.” Other limitations include the lack of measurements of patients’ total doses or adjusted doses per kilogram of body weight, a possible overtraining of the analysis model used to adjust for severity of illness, and a relatively low number of patients treated with dexmedetomidine, with most of such patients undergoing cardiac surgery.
Funding was provided by the Centers for Disease Control and Prevention. Dr. Klompas and the other researchers had no disclosures.
