6/28/23, 11:16 PM MENDS Pathway Feedback Search Clinical Topics Home Studies MENDS MENDS Disease ICU delirium Trial question Is dexmedetomidine superior to lorazepam in mechanically ventilated patients? Study design Multi-center Double blinded RCT Population Characteristics of study participants 49.0% female N = 103 51.0% male 103 patients (50 female, 53 male) Inclusion criteria: mechanically ventilated adult patients in medical and surgical ICU Key exclusion criteria: neurological disease; Childs-Pugh class B or C liver disease; moribund state with planned withdrawal of life support; alcohol abuse; active myocardial ischemia, severe dementia; benzodiazepine dependency Interventions N=52 dexmedetomidine (maximum infusion at 1.5 g/kg/hour titrated to achieve Richmond Agitation-Sedation Scale score) N=51 lorazepam (maximum infusion at 10 mg/hour titrated to achieve Richmond Agitation- Sedation Scale score) https://web.pathway.md/studies/recNRLT2KJyiI09oE 1/2 6/28/23, 11:16 PM MENDS Pathway Primary outcome Days alive without delirium or coma 7.0 days 7 5.3 days 3.5 days 3 1.8 days Significant increase 0.0 days Dexmedetomidine Lorazepam Significant increase in days alive without delirium or coma (7 days vs. 3 days; AD 4 days, 95% CI 0.96 to 7.04) Secondary outcomes Significant increase in the percentage of patients with delirium or coma (45% vs. 50%; ARD 5, 95% CI 0.48 to 9.52) Significant increase in Richmond Agitation-Sedation Scale score within 1 point of sedation goal (80% vs. 67%; AD 13%, 95% CI 0.57 to 25.43) No significant difference in death at day 28 (17% vs. 27%; RR 0.63, 95% CI -0.29 to 1.55) Safety outcomes No significant differences in seizures, self-extubations. Significant difference in sinus bradycardia (17% vs. 4%). Conclusion In mechanically ventilated adult patients in medical and surgical ICU, dexmedetomidine was superior to lorazepam with respect to days alive without delirium or coma. Reference Pratik P Pandharipande, Brenda T Pun, Daniel L Herr et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007 Dec 12;298(22):2644-53. Open reference URL https://web.pathway.md/studies/recNRLT2KJyiI09oE 2/2