Newer Sedative Might Help Patients on Ventilators
Mar. 23 -- TUESDAY, Dec. 11 (HealthDay News) -- Doctors routinely use sedatives on patients who are hooked up to mechanical ventilators in intensive care units, but some experts worry that too much sedation might slow down recovery and leave patients in an unnecessary fog.
Now, researchers report that by substituting a newer medication, dexmedetomidine (Precedex), for the more commonly used lorazepam (Ativan), doctors could reduce the amount of time patients experience delirium and coma. They also found a reduction in the length of time on mechanical ventilation and an improvement in survival, though these differences didn't reach the level of statistical significance.
"By changing the way we give medications, we may be able to improve outcomes," said study author Dr. Pratik Pandharipande, from the anesthesiology and critical care department at Vanderbilt University Medical Center in Nashville, Tenn. His report is published in the Dec. 12 issue of the Journal of the American Medical Association.
"By incorporating this sedative, patients had four more days alive without delirium or coma. They also had greater time off the mechanical ventilator and had shorter ICU stays. And, there was an important trend toward decreased mortality, about a 10 percent reduction in mortality," he said.
However, not everyone is convinced that the newer sedative is a significant improvement.
"This study reminds me of the importance in minimizing sedation. The principles of this study make sense to me, but the study is flawed. They started using 10 milligrams per hour of lorazepam, and it's a dose we don't use. It's a rarity to use a dose that high," said Dr. Kevin Grady, interim chief medical officer for St. John's Health System and director of pulmonary and critical care at St. John Hospital and Medical Center in Detroit. Grady said a more standard dose of lorazepam is 2 to 4 milligrams per hour.
"This just doesn't prove to me that dexmedetomidine is better than lorazepam," added Grady.
