Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/23868
Title: 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.
Austin Authors: Cioccari, Luca;Luethi, Nora;Bailey, Michael;Shehabi, Yahya;Howe, Belinda;Messmer, Anna S;Proimos, Helena K;Peck, Leah ;Young, Helen ;Eastwood, Glenn M ;Merz, Tobias M;Takala, Jukka;Jakob, Stephan M;Bellomo, Rinaldo 
Affiliation: Cardiovascular Intensive Care Unit (CVICU), Auckland City Hospital, Auckland, New Zealand
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Intensive Care
Clinical School of Medicine, University New South Wales, Sydney, Australia
Critical Care and Perioperative Services, School of Clinical Sciences, Monash University, Monash Health, Melbourne, Australia
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Issue Date: 16-Jul-2020
metadata.dc.date: 2020-07-16
Publication information: Critical Care 2020; 24(1): 441
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 between the two groups. Median NEq dose was 0.03 [0.01, 0.07] μg/kg/min in the DEX group and 0.04 [0.01, 0.16] μg/kg/min in the usual care group (p = 0.17). However, patients in the DEX group had a lower NEq/MAP ratio, indicating lower vasopressor requirements to maintain the target MAP. Moreover, on adjusted multivariable analysis, higher dexmedetomidine dose was associated with a lower NEq/MAP ratio. In critically ill patients with septic shock, patients in the DEX group received similar vasopressor doses in the first 48 h compared to the usual care group. On multivariable adjusted analysis, dexmedetomidine appeared to be associated with lower vasopressor requirements to maintain the target MAP. The SPICE III trial was registered at ClinicalTrials.gov ( NCT01728558 ).
URI: http://ahro.austin.org.au/austinjspui/handle/1/23868
DOI: 10.1186/s13054-020-03115-x
ORCID: 0000-0003-4993-427X
PubMed URL: 32678054
Type: Journal Article
Subjects: Dexmedetomidine
Hemodynamics
Noradrenaline
Sedation
Sepsis
Septic shock
Appears in Collections:Journal articles

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