- Design
- Planned secondary analysis of a randomised controlled trial
- Population
- 289 of 1,009 surviving mechanically ventilated ICU patients from A2B
- Primary outcome
- Intensive Care Experience Questionnaire domains at 90 days
- Effect
- Awareness: dexmedetomidine vs propofol +3.6 (95% CI 1.0–6.2); other domains no difference
A2B randomised mechanically ventilated ICU patients to dexmedetomidine, clonidine or propofol sedation and found no difference in time to extubation. This planned secondary analysis looked at what survivors recalled at 90 days using the Intensive Care Experience Questionnaire. Of 1,009 survivors, 289 (29%) completed it.
Compared with propofol, dexmedetomidine was associated with higher awareness of surroundings (median 32 vs 28; adjusted difference 3.6, 95% CI 1.0–6.2). Clonidine showed no clear difference. There were no differences in frightening memories, recall or satisfaction, and ventilation time, delirium and other mediators explained little of the awareness effect.
The authors themselves conclude this does not support choosing dexmedetomidine over propofol on patient experience. With fewer than a third of survivors responding, the result is hypothesis-generating.
- Continue to choose ICU sedatives on individual clinical need rather than recalled experience.
- Note that dexmedetomidine may leave patients more aware of their surroundings.
- Ask survivors about frightening ICU memories at follow-up, whatever sedative was used.
- Treat this as hypothesis-generating; most survivors did not complete the questionnaire.
Why it matters
Patient experience is often cited for dexmedetomidine, and this is the first trial-based look at it.
Don't overread it
Low response rate and a secondary outcome — it does not show dexmedetomidine improves ICU experience.
The statistics, in plain English
A 3.6-point difference on the awareness domain was statistically significant, but only 29% of survivors responded, so those who answered may differ from those who did not, and the result could shift with fuller data.
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