U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Dexmedetomidine for Sedation in the ICU or PICU: A Review of Cost-Effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014 Dec 17.

Cover of Dexmedetomidine for Sedation in the ICU or PICU: A Review of Cost-Effectiveness and Guidelines

Dexmedetomidine for Sedation in the ICU or PICU: A Review of Cost-Effectiveness and Guidelines [Internet].

Show details

APPENDIX 6EXCLUDED STUDIES OF POTENTIAL INTEREST

StudyFindings
Economic evaluations
Thoma et al. 20146Dexmedetomidine versus propofol:a
Total post-operative cost: $10,111 versus $12,859, and the incremental cost was −$2,748
Post-operative ICU cost: $4,494 versus $6,495, and the incremental cost was −$2,001
Patanwala et al. 20147Dexmedetomidine versus propofol: a
The median hospital cost (interquartile range): $46,716 ($31,247 to $85,490) versus $31,041 ($17,963 to $57,826)
Lachaine et al. 20128Dexmedetomidine versus midazolam: a
Total cost:
Base-case: $7,022 versus $7,680, and the incremental cost was −$658
Sensitivity analysis of time to extubation: $6,542 to 7,256 versus $6,886 to $7,918, and the incremental cost ranged from −$1,376 to $370
Scottish Medical Consortium 20129Dexmedetomidine versus propofol: a
Cost: £18,828 versus £20,307, and the incremental cost was −£1,479 Quality-adjusted life-year: the incremental utility was 0,001

Dexmedetomidine versus midazolam: a
Cost: £20,393 versus £22,536, and the incremental cost was −£2,143
Quality-adjusted life-year: the incremental utility was 0,002
All Wales Therapeutic and Toxicology Centre 201210Dexmedetomidine versus propofol: a
Cost: £21,897 versus £23,815, and the incremental cost was −£1,918
Quality-adjusted life-year: 0.058 versus 0.57, the incremental utility was 0,001
Incremental cost per QALY: Dexmedetomidine was dominant

Dexmedetomidine versus midazolam: a
Cost: £23,973 versus £26,602, and the incremental cost was −£2,629
Quality-adjusted life-year: 0.055 versus 0.052, the incremental utility was 0,002
Incremental cost per QALY: Dexmedetomidine was dominant
Dasta et al. 201011Dexmedetomidine versus midazolam: a
Total cost:
Total costs (unadjusted dataset): $27,694 versus $34,122, and the incremental cost was −$6,428

ICU component cost: $20,178 versus $25,618, and the incremental cost was −$5,440
a

costs are reported as they were published in the included studies without adjusting for inflation or differences in currency

ICU = intensive care unit; QALY = quality-adjusted life-year

StudyFindings
Evidence-based guidelines
Barr et al. 201312Recommendations related to dexmedetomidine:
  1. The guideline suggested that sedation strategies using non-benzodiazepine sedatives (propofol or dexmedetomidine) might be preferred over sedation with benzodiazepines (midazolam or lorazolam) to improve clinical outcomes in mechanically ventilated adult ICU patients. (Moderate quality evidence, weak recommendation)
  2. In mechanically ventilated adult ICU patients at risk of developing delirium, dexmedetomidine infusions administered for sedation might be associated with a lower prevalence of delirium compared to benzodiazepine infusions. (moderate quality evidence_ strength of recommendation was not reported).
  3. The guidelines suggested that in adult ICU patients with delirium unrelated to alcohol or benzodiazepine withdrawal, continuous IV infusions of dexmedetomidine rather than benzodiazepine infusions be administered for sedation to reduce the duration of delirium in these patients. (moderate quality evidence, weak recommendation).
Celis-Rodriguez et al. 201313
  1. Patients requiring conscious or cooperative sedation:
    • The use of dexmedetomidine, fentanyl, remifentanill, propofol, or midazolam in doses titrated according to response is recommended for conscious sedation in minor therapeutic, diagnostic or surgical situations in ICU. (Moderate quality of evidence, strong recommendation)
  2. Patients with delirium and withdrawal syndrome:
    • Antipsychotics and/or dexmedetomidine are recommended for the drug treatment of delirium. (Moderate quality of evidence, strong recommendation)
    • Dexmedetomidine is recommended as an ulternative in the management of delirium. (Moderate quality of evidence, strong recommendation)
  3. Withdrawal syndrome in the intensive care unit:
    • The use of dexmedetomidine or clonidine is suggested to facilitate the withdrawal of sedatives and opioids and to treat withdrawal syndrome. (Moderate quality of evidence, weak recommendation)
  4. Withdrawal syndrome due to alcohol:
    • The use of dexmedetomidine is suggested as a coadjuvant to treatment with benzodiazepines in the management of withdrawal syndrome due to alcohol.
  5. Patients without tracheal intubation or ventilatory support
    • it is advisable to use drugs with a low risk of producing respiratory depression and severe hemodynamic adverse effects, such as haloperidol and dexmedetomidine. (Low quality of evidence, strong recommendation)
  6. Patients with mechanical ventilation:
    • Whenever possible, it is advisable to use conscious or cooperative sedation with titrated doses of a continuous infusion of propofol or dexmedetomidine. (Moderate quality of evidence, strong recommendation).
    • The use of a sedative with a shorter half-life, such as dexmedetomidine, is recommended for reducing the duration of MV and the incidence of delirium in patients that can tolerate mild sedation levels (RASS 1 to −3 or Ramsay 2---3). (Moderate quality of evidence, strong recommendation).
    • Dexmedetomidine is recommended as a useful drug for postoperative sedation and analgesia in patients requiring MV for short periods of time, and particularly in septic patients. (Moderate quality of evidence, strong recommendation).
  7. Patients undergoing withdrawal of the endotracheal tube and mechanical ventilation:
    • Dexmedetomidine is recommended in postsurgical patients. (Low quality of evidence, strong recommendation).
    • Dexmedetomidine is recommended in patients with mechanical ventilation weaning difficulties and in patients with withdrawal syndrome. (Low quality of evidence, strong recommendation).
    • Dexmedetomidine is recommended in patients with failed previous attempts of weaning from MV secondary to agitation and delirium. (Low quality of evidence, strong recommendation).
  8. Special procedures (burn victims):
    • It is advisable not to use ketamine alone. The drug should be accompanied by midazolam, propofol or dexmedetomidine. (Moderate quality of evidence, strong recommendation).
  9. Sedoanalgesia in the immediate postoperative period of cardiovascular surgery:
    • The use of dexmedetomidine, remifentanil or their combination, the combination of low-dose propofol and midazolam, or the combination of propofol and fentanyl are recommended for postoperative sedation and analgesia. (Moderate quality of evidence, strong recommendation).
    • Dexmedetomidine is recommended among patients in the postoperative period of cardiovascular surgery, either as single drug or combined with opioid analgesics. (Moderate quality of evidence, strong recommendation).
  10. Neurological and neurocritical patients:
    • It is advisable to use drugs with a short half-life and scant accumulation (propofol, dexmedetomidine and remifentanil), allowing frequent neurological evaluations. (Moderate quality of evidence, strong recommendation).
  11. Patients with renal failure:
    • The use of dexmedetomidine is recommended, reducing the loading dose and adjusting the infusion according to the clinical response obtained. (Low quality of evidence, strong recommendation).
  12. Patients with liver failure:
    • Dexmedetomidine is suggested as coadjuvant treatment in cirrhotic patients with alcohol withdrawal syndrome, when conventional management fails. The dose should be lowered. (Moderate quality of evidence, weak recommendation).
Copyright © 2014 Canadian Agency for Drugs and Technologies in Health.

Copyright: This report contains CADTH copyright material and may contain material in which a third party owns copyright. This report may be used for the purposes of research or private study only. It may not be copied, posted on a web site, redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner.

Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

Bookshelf ID: NBK268689
Contents

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (507K)

Other titles in this collection

Recent Activity

ClearTurn OffTurn On

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...