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Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients: a rapid practice guideline

Research output: Contribution to journalArticlepeer-review

Morten H. Møller, Waleed Alhazzani, Kimberley Lewis, Emilie Belley-Cote, Anders Granholm, John Centofanti, William B. McIntyre, Jessica Spence, Zainab Al Duhailib, Dale M. Needham, Laura Evans, Annika Reintam Blaser, Margaret A. Pisani, Frederick D’Aragon, Manu Shankar-Hari, Mohammed Alshahrani, Giuseppe Citerio, Rakesh C. Arora, Sangeeta Mehta, Timothy D. Girard & 6 more Otavio T. Ranzani, Naomi Hammond, John W. Devlin, Yahya Shehabi, Pratik Pandharipande, Marlies Ostermann

Original languageEnglish
Pages (from-to)801-810
Number of pages10
JournalIntensive Care Medicine
Volume48
Issue number7
DOIs
Accepted/In press2022
PublishedJul 2022

Bibliographical note

Funding Information: We are very grateful to the patient representatives Olaf Schroeder and Maria Høpner for being members of the guideline panel. Publisher Copyright: © 2022, Springer-Verlag GmbH Germany, part of Springer Nature.

King's Authors

Abstract

Purpose: The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM‑RPG) was to formulate evidence‑based guidance for the use of dexmedetomidine for sedation in invasively mechanically ventilated adults in the intensive care unit (ICU). Methods: We adhered to the methodology for trustworthy clinical practice guidelines, including use of the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence, and the Evidence-to-Decision framework to generate recommendations. The guideline panel comprised 28 international panelists, including content experts, ICU clinicians, methodologists, and patient representatives. Through teleconferences and web‑based discussions, the panel provided input on the balance and magnitude of the desirable and undesirable effects, the certainty of evidence, patients’ values and preferences, costs and resources, feasibility, acceptability, and research priorities. Results: The ICM‑RPG panel issued one weak recommendation (suggestion) based on overall moderate certainty of evidence: "In invasively mechanically ventilated adult ICU patients, we suggest using dexmedetomidine over other sedative agents, if the desirable effects including a reduction in delirium are valued over the undesirable effects including an increase in hypotension and bradycardia". Conclusion: This ICM-RPG provides updated evidence-based guidance on the use of dexmedetomidine for sedation in mechanically ventilated adults, and outlines uncertainties and research priorities.

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