Is dexmedetomidine safer than usual care for critically ill older adults?

The incidence of adverse events among critically ill older patients is similar between those receiving dexmedetomidine and those receiving usual care, a study has shown.

“Recent trials demonstrated no difference in clinical outcomes between patients treated with dexmedetomidine vs usual care, but significantly more haemodynamic adverse effects in the dexmedetomidine group,” the authors said.

“One subgroup analysis suggested a 90-day mortality benefit in [older] patients, but no distinction was made between groups regarding age when reporting adverse effects,” they added.

This single-centre, retrospective study sought to examine the incidence of adverse haemodynamic effects of dexmedetomidine in older patients admitted to the intensive care unit (ICU) compared with other sedative agents and to clarify the role of the study drug in this patient population.

Participants in this study were mechanically ventilated and required sedative agents for ≥12 hours. The primary outcome was the composite of bradycardia and hypotension incidence, while secondary outcomes included incidence of each adverse event, hospital and ICU length of stay, and duration of mechanical ventilation.

No significant difference in adverse events were observed between the dexmedetomidine and usual care groups (58.7 percent vs 74.1 percent, respectively; p=0.074). No between-group difference was also seen in hospital or ICU length of stay.

However, patients who received dexmedetomidine had longer ventilator use than those who received usual care (median, 6 vs 3 days; p=0.004).

Dexmedetomidine is the recommended first-line sedative medication for critically ill patients requiring mechanical ventilation, according to the authors.