MENDS

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Pandharipande PP, et al. "Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial". JAMA. 2007. 298(22):2644-2653.
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Clinical Question

Among mechanically ventilated ICU patients, does dexmedetomidine reduce duration of delirium and coma as compared to lorazepam?

Bottom Line

Major Points

Design

  • Multicenter, double-blind, randomized, controlled trial
  • N=106
    • Dexmedetomidine (n=54)
    • Lorazepam (n=52)
  • Setting: 2 centers
    • Vanderbilt University Medical Center, Nashville, Tennessee
    • Washington Hospital Center, Washington, DC
  • Enrollment: August 2004 to April 2006
  • Analysis: Intention-to-treat

Population

Inclusion Criteria

  • Age ≥18 years
  • Intubated and mechanically ventilated for >24 hours

Exclusion Criteria

  • Neurological disease
    • Previous stroke
    • Cerebral Palsy
    • Severe Dementia
  • Childs-Pugh Class
  • Moribund state with planned withdraw of life support
  • Physician refusal
  • Alcohol abuse
  • Benzodiazepine dependency
  • Active MI
  • Second or Third degree heart block
  • Pregnancy or Lactating
  • Severe hearing disabilities

Baseline Characteristics

Interventions

Outcomes

Criticisms