Efficacy and Safety of Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients in Intensive Care Unit: A study in a tertiary care hospital, Dhaka, Bangladesh

Abstract

Introduction: Sedation with Midazolam in intensive care unit (ICU) has some adverse effects.Dexmedetomidine, an a2 agonist available for ICU sedation may reduce adverse effects and enhance patients’ comfort. Objectives: To compare the efficacy and safety betweenDexmedetomidine vs Midazolam for sedation of critically ill patientsin ICU. Methods and Materials: Thiswas a prospective open label randomized trial conducted at ICU in Kurmitola General Hospital, Dhaka, Bangladesh on 60 patients of either sex, age above 18 years requiring mechanical ventilation. The study period extended from January, 2019 to December, 2019. Interventions: Dexmedetomidine {(0.2-0.8ug/kg/hour. (n=30)}andMidazolam {(0.02-0.1 mg/kg/hour (n=30)} titrated to achieve mild to moderatesedation (RASS scores-2 to+1). Sedation was continued as long as clinically indicated. Results: In this study time in target sedation range were 80% in Dexmedetomidine group and 76.67% in Midazolam group (p value=0.756). In Dexmedetomidine group 86.67% patients completing all daily arousal assessment and were 83.33% in Midazolam group (p value=0.718). There was no significant difference between two groups in case of efficacy outcome. In case of safety outcome, the most significant adverse effect of Dexmedetomidine was bradycardia (p value = 0.02) and most significant adverse effect of Midazolam was tachycardia (p value = 0.0001). There was a minimal difference noted in infection and mortality in both the groups. Conclusion: There was no significant difference between Dexmedetomidine and Midazolam in time at targeted sedation level in mechanically ventilated ICU patients. At comparable sedation levels, both Dexmedetomidine and Midazolamtreated patients completing all daily arousal assessment.