- Design
- Planned secondary analysis of a randomised controlled trial
- Population
- 289 ICU survivors who completed the ICE-Q at 90 days
- Primary outcome
- Patient-recalled ICU experience (four ICE-Q domains)
- Effect
- Awareness: dexmedetomidine vs propofol +3.6 (1.0-6.2); no other domain differed
A planned secondary analysis of the A2B trial (Anaesthesia, 6 October 2026) used the Intensive Care Experience Questionnaire at 90 days in 289 survivors, out of 1,009 alive, who had been randomised to dexmedetomidine, clonidine or propofol sedation.
Compared with propofol, dexmedetomidine was associated with higher awareness of surroundings (adjusted mean difference 3.6, 95% CI 1.0-6.2). Clonidine showed no clear association (2.4, -0.2 to 5.0). There were no differences in frightening memories, recall or satisfaction, and ventilation time, agitation and delirium explained little of the awareness effect.
The primary A2B trial did not show faster liberation from ventilation with the alpha-2 agonists. Together, the authors conclude these data do not support choosing dexmedetomidine over propofol for patient experience, and sedation should remain individualised.
- Keep sedative choice individualised; this does not favour dexmedetomidine over propofol
- Aim for light sedation and regular assessment whichever agent is used
- Ask survivors about their ICU memories at follow-up clinic
Why it matters
It closes off patient experience as a reason to switch sedative, at least on current evidence.
Don't overread it
A secondary analysis with low questionnaire return - not evidence for changing sedation practice.
The statistics, in plain English
Only 29% of survivors returned questionnaires, so those who answered may differ from those who did not. The awareness difference has an interval excluding zero, but other domains showed nothing and this is a hypothesis-generating subgroup.
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