Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/16535
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dc.contributor.authorReade, Michael C-
dc.contributor.authorEastwood, Glenn M-
dc.contributor.authorBellomo, Rinaldo-
dc.contributor.authorBailey, Michael-
dc.contributor.authorBersten, Andrew-
dc.contributor.authorCheung, Benjamin-
dc.contributor.authorDavies, Andrew-
dc.contributor.authorDelaney, Anthony-
dc.contributor.authorGhosh, Angaj-
dc.contributor.authorvan Haren, Frank-
dc.contributor.authorHarley, Nerina-
dc.contributor.authorKnight, David-
dc.contributor.authorMcGuiness, Shay-
dc.contributor.authorMulder, John-
dc.contributor.authorO’Donoghue, Steve-
dc.contributor.authorSimpson, Nicholas-
dc.contributor.authorYoung, Paul-
dc.contributor.authorDahLIA Investigators-
dc.contributor.authorAustralian and New Zealand Intensive Care Society Clinical Trials Group-
dc.date.accessioned2017-01-23T00:25:08Z-
dc.date.available2017-01-23T00:25:08Z-
dc.date.issued2016-04-12-
dc.identifier.citationJAMA 2016; 315(14): 1460-1468en_US
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/16535-
dc.descriptionErratum in: Expanded Explanation of the Sample Size Calculation. JAMA 2016; 316(7): 775. doi: 10.1001/jama.2016.9458.en_US
dc.description.abstractIMPORTANCE: Effective therapy has not been established for patients with agitated delirium receiving mechanical ventilation. OBJECTIVE: To determine the effectiveness of dexmedetomidine when added to standard care in patients with agitated delirium receiving mechanical ventilation. DESIGN, SETTING, AND PARTICIPANTS: The Dexmedetomidine to Lessen ICU Agitation (DahLIA) study was a double-blind, placebo-controlled, parallel-group randomized clinical trial involving 74 adult patients in whom extubation was considered inappropriate because of the severity of agitation and delirium. The study was conducted at 15 intensive care units in Australia and New Zealand from May 2011 until December 2013. Patients with advanced dementia or traumatic brain injury were excluded. INTERVENTIONS: Bedside nursing staff administered dexmedetomidine (or placebo) initially at a rate of 0.5 µg/kg/h and then titrated to rates between 0 and 1.5 µg/kg/h to achieve physician-prescribed sedation goals. The study drug or placebo was continued until no longer required or up to 7 days. All other care was at the discretion of the treating physician. MAIN OUTCOMES AND MEASURES: Ventilator-free hours in the 7 days following randomization. There were 21 reported secondary outcomes that were defined a priori. RESULTS: Of the 74 randomized patients (median age, 57 years; 18 [24%] women), 2 withdrew consent later and 1 was found to have been randomized incorrectly, leaving 39 patients in the dexmedetomidine group and 32 patients in the placebo group for analysis. Dexmedetomidine increased ventilator-free hours at 7 days compared with placebo (median, 144.8 hours vs 127.5 hours, respectively; median difference between groups, 17.0 hours [95% CI, 4.0 to 33.2 hours]; P = .01). Among the 21 a priori secondary outcomes, none were significantly worse with dexmedetomidine, and several showed statistically significant benefit, including reduced time to extubation (median, 21.9 hours vs 44.3 hours with placebo; median difference between groups, 19.5 hours [95% CI, 5.3 to 31.1 hours]; P < .001) and accelerated resolution of delirium (median, 23.3 hours vs 40.0 hours; median difference between groups, 16.0 hours [95% CI, 3.0 to 28.0 hours]; P = .01). Using hierarchical Cox modeling to adjust for imbalanced baseline characteristics, allocation to dexmedetomidine was significantly associated with earlier extubation (hazard ratio, 0.47 [95% CI, 0.27-0.82]; P = .007). CONCLUSIONS AND RELEVANCE: Among patients with agitated delirium receiving mechanical ventilation in the intensive care unit, the addition of dexmedetomidine to standard care compared with standard care alone (placebo) resulted in more ventilator-free hours at 7 days. The findings support the use of dexmedetomidine in patients such as these. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01151865.en_US
dc.subjectDeleriumen_US
dc.subjectHypnotics and sedativesen_US
dc.subjectDexmedetomidineen_US
dc.subjectPsychomotor Agitationen_US
dc.subjectRespirationen_US
dc.titleEffect of dexmedetomidine added to standard care on ventilator-free time in patients with agitated delirium: a randomized clinical trialen_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleJAMAen_US
dc.identifier.affiliationBurns, Trauma, and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australiaen_US
dc.identifier.affiliationJoint Health Command, Australian Defence Force, Brisbane, Queensland, Australiaen_US
dc.identifier.affiliationAustin Health, Heidelberg, Victoria, Australiaen_US
dc.identifier.affiliationSchool of Medicine, University of Melbourne, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationAustralian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationFlinders Medical Centre, Adelaide, South Australia, Australiaen_US
dc.identifier.affiliationToowoomba Hospital, Toowoomba, Queensland, Australiaen_US
dc.identifier.affiliationPeninsula Health, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationRoyal North Shore Hospital of Sydney, Sydney, NSW, Australiaen_US
dc.identifier.affiliationNorthern Hospital, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationCanberra Hospital, Canberra, ACT, Australiaen_US
dc.identifier.affiliationRoyal Melbourne Hospital, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationChristchurch Hospital, Christchurch, New Zealanden_US
dc.identifier.affiliationAuckland City Hospital, Auckland, New Zealanden_US
dc.identifier.affiliationWestern Hospital, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationRoyal Brisbane and Women’s Hospital, Brisbane, Queensland, Australiaen_US
dc.identifier.affiliationGeelong Hospital, Geelong, Victoria, Australiaen_US
dc.identifier.affiliationWellington Hospital, Wellington, New Zealanden_US
dc.identifier.affiliationMedical Research Institute of New Zealand, Wellingtonen_US
dc.identifier.pubmedurihttps://pubmed.ncbi.nlm.nih.gov/26975647en_US
dc.identifier.doi10.1001/jama.2016.2707en_US
dc.type.contentTexten_US
dc.identifier.orcid0000-0002-1650-8939-
dc.type.austinJournal Articleen_US
local.name.researcherBellomo, Rinaldo
item.openairetypeJournal Article-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.grantfulltextnone-
item.fulltextNo Fulltext-
item.cerifentitytypePublications-
crisitem.author.deptIntensive Care-
crisitem.author.deptIntensive Care-
crisitem.author.deptData Analytics Research and Evaluation (DARE) Centre-
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