ICU sedation with dexmedetomidine was linked to more recalled awareness, not better experience overall

Design

Planned secondary analysis of a randomised trial

Population

289 ICU survivors of the A2B trial who completed the questionnaire at 90 days

Primary outcome

Intensive Care Experience Questionnaire domains

Effect

Dexmedetomidine vs propofol awareness difference 3.6 (95% CI 1.0 to 6.2); no difference in other domains

A2B randomised mechanically ventilated ICU patients to dexmedetomidine, clonidine or propofol sedation; the main trial found no difference in time on the ventilator. This planned secondary analysis looked at what survivors recalled at 90 days using the Intensive Care Experience Questionnaire. Only 289 of 1,009 survivors returned it.

Compared with propofol, dexmedetomidine was associated with higher awareness of surroundings (median score 32 vs 28; adjusted difference 3.6, 95% CI 1.0 to 6.2). Clonidine showed no clear difference. There were no differences in frightening memories, overall recall or satisfaction.

The authors conclude that these findings do not support choosing dexmedetomidine over propofol for patient experience, and that sedation should stay individualised.

• Choose ICU sedative agents on clinical grounds; patient-reported experience does not favour one agent in this analysis.
• Aim for light sedation and daily review, whichever agent is used.
• Ask ICU survivors about frightening memories at follow-up, whichever sedative they received.
• Recognise that dexmedetomidine may leave patients more aware of their surroundings.

Why it matters

Dexmedetomidine is often promoted as giving a better ICU experience; patient recall here did not show that overall.

Don't overread it

Fewer than three in ten survivors answered the questionnaire, so the responders may not represent all patients.

The statistics, in plain English

An adjusted difference of 3.6 points (95% CI 1.0 to 6.2) on the awareness domain is statistically clear, but the clinical meaning of a few points on this scale is uncertain, and with low response rates selection bias is a real concern.

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