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Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients: a rapid practice guideline. 2022
Morten H Møller, and
Waleed Alhazzani, and
Kimberley Lewis, and
Emilie Belley-Cote, and
Anders Granholm, and
John Centofanti, and
William B McIntyre, and
Jessica Spence, and
Zainab Al Duhailib, and
Dale M Needham, and
Laura Evans, and
Annika Reintam Blaser, and
Margaret A Pisani, and
Frederick D'Aragon, and
Manu Shankar-Hari, and
Mohammed Alshahrani, and
Giuseppe Citerio, and
Rakesh C Arora, and
Sangeeta Mehta, and
Timothy D Girard, and
Otavio T Ranzani, and
Naomi Hammond, and
John W Devlin, and
Yahya Shehabi, and
Pratik Pandharipande, and
Marlies Ostermann
Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. mortenhylander@gmail.com.
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). 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. 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". 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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