The effect of dexmedetomidine on vasopressor requirements in patients with septic shock: a subgroup analysis of the Sedation Practice in Intensive Care Evaluation [SPICE III] Trial.

Critical Care : the Official Journal of the Critical Care Forum
Luca CioccariANZICS Clinical Trials Group and the SPICE III Investigators

Abstract

Septic shock is associated with decreased vasopressor responsiveness. Experimental data suggest that central alpha2-agonists like dexmedetomidine (DEX) increase vasopressor responsiveness and reduce catecholamine requirements in septic shock. However, DEX may also cause hypotension and bradycardia. Thus, it remains unclear whether DEX is hemodynamically safe or helpful in this setting. In this post hoc subgroup analysis of the Sedation Practice in Intensive Care Evaluation (SPICE III) trial, an international randomized trial comparing early sedation with dexmedetomidine to usual care in critically patients receiving mechanical ventilation, we studied patients with septic shock admitted to two tertiary ICUs in Australia and Switzerland. The primary outcome was vasopressor requirements in the first 48 h after randomization, expressed as noradrenaline equivalent dose (NEq [μg/kg/min] = noradrenaline + adrenaline + vasopressin/0.4). Between November 2013 and February 2018, 417 patients were recruited into the SPICE III trial at both sites. Eighty-three patients with septic shock were included in this subgroup analysis. Of these, 44 (53%) received DEX and 39 (47%) usual care. Vasopressor requirements in the first 48 h were similar b...Continue Reading

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Citations

Sep 22, 2020·Seminars in Respiratory and Critical Care Medicine·Yahya ShehabiBelinda Howe
Feb 11, 2021·Critical Care : the Official Journal of the Critical Care Forum·Auguste DargentJean-Pierre Quenot
Jan 16, 2021·British Journal of Pharmacology·Yugeesh R LankadevaClive N May
Jul 5, 2021·Anaesthesia Critical Care & Pain Medicine·Yahya ShehabiRinaldo Bellomo

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Methods Mentioned

BETA
Sedation

Software Mentioned

SPICE
SAS

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