🩺 Clinical implications:
1️⃣ Routine switch from propofol-based sedation is not supported
2️⃣ In patients requiring deep sedation, Dex/Clon may be suboptimal due to agitation
3️⃣ Monitor for bradycardia when using Dex or Clon

📄 Full article:
jamanetwork.com/journals/jam...

💡 Interpretation:
Dex and Clon were expected to facilitate extubation due to lighter sedation

However, in ~25–30% of cases, deep sedation was unavoidable

High propofol co-use diluted between-group differences

No reduction in delirium with dex, contrary to prior hopes

⚠️ Safety concerns:
Bradycardia (HR < 50): Increased with both Dex and Clon
Agitation (RASS +3–4): Also increased in both groups
Delirium (via CAM-ICU): No difference

💉 Real-world sedation use:
Target RASS: –2 to +1
20–30% required deep sedation per clinician judgment
Even in Dex/Clon groups, propofol was used during ~75–77% of sedation days

🎯 Primary outcome: No difference in time to extubation success across groups

🏥 Overview:
41 ICUs, 1,404 patients

🧩 PICO (3-arm):
P: Adults expected to require ≥48h of MV
I: Sedation primarily with ① dexmedetomidine or ② clonidine
C: Sedation primarily with propofol
O: Time from randomization to 48h of sustained spontaneous breathing (i.e., extubation success)

So, true.

Thanks a lot for our paper!
journals.lww.com/ccmjournal/f...