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Critical Care
Published in: Critical Care 4/2010

01-08-2010 | Letter

Alpha-2 adrenoceptor agonists and sepsis: improved survival?

Author: Luc Quintin

Published in: Critical Care | Issue 4/2010

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Excerpt

Dr Pandharipande and colleagues should be commended for segregating the effect of dexmedetomidine, an alpha-2 adrenoceptor agonist, in sepsis [1]. However, three questions arise from their study: what are the P- values for the data reported in Table 1? Why was there such a discrepancy between the fentanyl dose given to patients on dexmedetomidine and those on lorazepam (1,114 versus 117 μg/day, P = 0.01) considering the 50 to 80% reduction in the use of opiates commonly observed in the literature when alpha-2 adrenoceptor agonists are administered? And how many days did the patients spend on spontaneous (for example, pressure support) versus controlled/assisted ventilation? …
Literature
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Pandharipande PP, Sanders RD, Girard TD, McGrane S, Thompson JL, Shintani AK, Herr DL, Maze M, Ely EW, Mends IT: Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori -designed analysis of the MENDS randomized controlled trial. Crit Care 2010, 14: R38. 10.1186/cc8916PubMedCentralCrossRefPubMed
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Gregorakos L, Kerezoudi E, Dimopoulos G, Thomaides T: Management of blood pressure instability in severe tetanus: the use of clonidine. Intensive Care Med 1997, 23: 893-895. 10.1007/s001340050428CrossRefPubMed
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Pichot C, Mathern P, Khettab F, Ghignone M, Geloen A, Quintin L: Increased pressor response to noradrenaline during septic shock following clonidine? Anesthesia Intensive Care (Sydney) 2010, in press.
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Venn RM, Newman PJ, Grounds RM: A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Int Care Med 2003, 29: 201-207.
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Spies CD, Dubisz N, Neumann T, Blum S, Muller C, Rommelspacher H, Brummer G, Specht M, Sanft C, Hannemann L, Striebel HW, Schaff artzik W: Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomized trial. Crit Care Med 1996, 24: 414-422. 10.1097/00003246-199603000-00009CrossRefPubMed
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Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG: Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 2009, 301: 489-499. 10.1001/jama.2009.56CrossRefPubMed
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Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, Shintani AK, Thompson JL, Jackson JC, Deppen SA, Stiles RA, Dittus RS, Bernard GR, Ely EW: Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 2007, 298: 2644-2653. 10.1001/jama.298.22.2644CrossRefPubMed
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Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ: The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg 2004, 98: 153-158. 10.1213/01.ANE.0000093225.39866.75CrossRefPubMed
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Venn RM, Grounds RM: Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions. Br J Anaesth 2001, 87: 684-690. 10.1093/bja/87.5.684CrossRefPubMed
Metadata
Title
Alpha-2 adrenoceptor agonists and sepsis: improved survival?
Author
Luc Quintin
Publication date
01-08-2010
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2010
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc9096

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