The stress response may be affected in various ways by sedative drugs. Dexmedetomidine, an alpha2-adrenergic agonist, is typically reserved for use as a secondary sedative in patients requiring mechanical ventilation. Researchers hypothesized that critically ill people would have a lower stress response to early sedation with dexmedetomidine as the principal agent than to typical sedatives. Within a larger multi-center randomized controlled trial comparing early sedation with dexmedetomidine to standard care, they conducted this prospective sub-study. The primary endpoint was the 5-day mean difference between groups in plasma concentrations of stress response indicators. A wide range of hormone, biochemical, and physiological data were gathered. Patients with confirmed or suspected cases of sepsis were to be the focus of the planned subgroup analysis.

About 103 patients were considered for this study’s final tally. Comparable rates of propofol use and median doses were seen across groups, as was the baseline severity of illness (APACHE II score). More of the usual-care patients received midazolam (57.7% vs. 33.3%; P=0.01) and at a higher dose (median (95% interquartile range) of 0.46 [0.20–0.93] vs. 0.14 [0.08–0.38] mg/kg/day; P<0.01). Adrenaline (0.32 [0.26-0.4] vs. 0.38 [0.31-0.48]), noradrenaline (4.27 [3.12-5.85] vs. 6.2 [4.6-8.5]), adrenocorticotropic hormone (17.1 [15.1-19.5] vs. 18.1 [15.9-20.5]), and cortisol (515 [409-648] vs. 618 [491-776)] plasma levels did not differ between Other biomarkers and physiological indicators were not significantly different. Both age and sepsis were shown to have no impact in sensitivity studies.

Changes in physiological and blood-borne markers linked with the stress response were similar between early sedation with dexmedetomidine as the major sedative agent and standard-of-care sedation in mechanically ventilated critically ill people.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-022-04237-0