Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients: a rapid practice guideline

Morten H Møller¹, Waleed Alhazzani^{2

3}, Kimberley Lewis², Emilie Belley-Cote⁴, Anders Granholm⁵, John Centofanti⁶, William B McIntyre^{7

8}, Jessica Spence^{3

9}, Zainab Al Duhailib¹⁰, Dale M Needham¹¹, Laura Evans¹², Annika Reintam Blaser^{13

14}, Margaret A Pisani¹⁵, Frederick D'Aragon^{16

17}, Manu Shankar-Hari¹⁸, Mohammed Alshahrani¹⁹, Giuseppe Citerio²⁰, Rakesh C Arora²¹, Sangeeta Mehta²², Timothy D Girard²³, Otavio T Ranzani^{24

25}, Naomi Hammond^{26

27}, John W Devlin^{28

29}, Yahya Shehabi^{30

31}, Pratik Pandharipande³², Marlies Ostermann³³

Affiliations

¹ Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. mortenhylander@gmail.com.
² Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada.
³ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁴ Divisions of Cardiology and Critical Care, McMaster University, Hamilton, ON, Canada.
⁵ Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
⁶ Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
⁷ Population Health Research Institute, Hamilton, ON, Canada.
⁸ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁹ Department of Anesthesia and Critical Care, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
¹¹ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA.
¹² Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, USA.
¹³ Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
¹⁴ Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
¹⁵ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, 06501, USA.
¹⁶ Department of Anesthesiology, Universite de Sherbrooke, Sherbrooke, QC, Canada.
¹⁷ Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
¹⁸ Centre for Inflammation Research, The University of Edinburgh The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
¹⁹ Department of Emergency and Critical Care, College of Medicine, Imam Abdulrahman Ben Faisal University, Dammam, Saudi Arabia.
²⁰ School of Medicine and Surgery, University Milano-Bicocca; Neurorianimazione, ASST-Monza, Monza, Italy.
²¹ Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
²² Department of Medicine, Sinai Health, and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
²³ Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
²⁴ Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain.
²⁵ Pulmonary Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, São Paulo, SP, Brazil.
²⁶ Critical Care Program, The George Institute for Global Health and UNSW Sydney, Newtown, NSW, Australia.
²⁷ Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia.
²⁸ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.
²⁹ School of Pharmacy, Northeastern University, Boston, MA, USA.
³⁰ Department of Intensive Care, Monash Health School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia.
³¹ School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.
³² Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
³³ Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK.

PMID: 35587274
DOI: 10.1007/s00134-022-06660-x

Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients: a rapid practice guideline

Morten H Møller et al. Intensive Care Med. 2022 Jul.

. 2022 Jul;48(7):801-810.

doi: 10.1007/s00134-022-06660-x. Epub 2022 May 19.

Authors

Affiliations

¹ Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. mortenhylander@gmail.com.
² Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada.
³ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁴ Divisions of Cardiology and Critical Care, McMaster University, Hamilton, ON, Canada.
⁵ Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
⁶ Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
⁷ Population Health Research Institute, Hamilton, ON, Canada.
⁸ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁹ Department of Anesthesia and Critical Care, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
¹¹ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA.
¹² Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, USA.
¹³ Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
¹⁴ Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
¹⁵ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, 06501, USA.
¹⁶ Department of Anesthesiology, Universite de Sherbrooke, Sherbrooke, QC, Canada.
¹⁷ Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
¹⁸ Centre for Inflammation Research, The University of Edinburgh The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
¹⁹ Department of Emergency and Critical Care, College of Medicine, Imam Abdulrahman Ben Faisal University, Dammam, Saudi Arabia.
²⁰ School of Medicine and Surgery, University Milano-Bicocca; Neurorianimazione, ASST-Monza, Monza, Italy.
²¹ Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
²² Department of Medicine, Sinai Health, and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
²³ Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
²⁴ Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain.
²⁵ Pulmonary Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, São Paulo, SP, Brazil.
²⁶ Critical Care Program, The George Institute for Global Health and UNSW Sydney, Newtown, NSW, Australia.
²⁷ Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia.
²⁸ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.
²⁹ School of Pharmacy, Northeastern University, Boston, MA, USA.
³⁰ Department of Intensive Care, Monash Health School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia.
³¹ School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.
³² Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
³³ Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK.

PMID: 35587274
DOI: 10.1007/s00134-022-06660-x

Abstract

Purpose: The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM‑RPG) was to formulate evidence‑based guidance for the use of dexmedetomidine for sedation in invasively mechanically ventilated adults in the intensive care unit (ICU).

Methods: We adhered to the methodology for trustworthy clinical practice guidelines, including use of the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence, and the Evidence-to-Decision framework to generate recommendations. The guideline panel comprised 28 international panelists, including content experts, ICU clinicians, methodologists, and patient representatives. Through teleconferences and web‑based discussions, the panel provided input on the balance and magnitude of the desirable and undesirable effects, the certainty of evidence, patients' values and preferences, costs and resources, feasibility, acceptability, and research priorities.

Results: The ICM‑RPG panel issued one weak recommendation (suggestion) based on overall moderate certainty of evidence: "In invasively mechanically ventilated adult ICU patients, we suggest using dexmedetomidine over other sedative agents, if the desirable effects including a reduction in delirium are valued over the undesirable effects including an increase in hypotension and bradycardia".

Conclusion: This ICM-RPG provides updated evidence-based guidance on the use of dexmedetomidine for sedation in mechanically ventilated adults, and outlines uncertainties and research priorities.

Keywords: Clinical practice guideline; Dexmedetomidine; ICM-RPG; Sedation.

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References

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Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients: a rapid practice guideline

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Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients: a rapid practice guideline

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