Dexmedetomidine, Propofol give similar outcomes in septic ventilated patients: MENDS2 trial

USA: The administration of dexmedetomidine or propofol yields similar outcomes in mechanically ventilated adults with sepsis being treated with light sedation, according to findings from the MENDS2 trial. The findings of the study were presented at the 2021 virtual Clinical Congress of the Society of Critical Care Medicine and simultaneously published in The New England Journal of Medicine. 

Current guidelines recommend targeting light sedation with propofol or dexmedetomidine for adults receiving mechanical ventilation. There are differences between these sedatives in inflammation, immunity, and arousability. However, it is still not known of they have differential outcomes in mechanically ventilated adults with sepsis undergoing light sedation. 

Against the above background, Christopher G. Hughes, professor of anesthesiology at Vanderbilt University Medical Center, in Nashville, Tenn., and colleagues set up the ENDS2 (Maximizing the Efficacy of Sedation and Reducing Neurological Dysfunction and Mortality in Septic Patients with Acute Respiratory Failure) trial -- a multicenter, double-blind trial.

Mechanically ventilated adults with sepsis were randomly assigned to receive dexmedetomidine (0.2 to 1.5 μg per kilogram of body weight per hour) or propofol (5 to 50 μg per kilogram per minute), with doses adjusted by bedside nurses to achieve target sedation goals set by clinicians according to the Richmond Agitation–Sedation Scale (RASS, on which scores range from −5 [unresponsive] to +4 [combative]).