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dc.contributor.authorShehabi, Yahya-
dc.contributor.authorSerpa Neto, Ary-
dc.contributor.authorBellomo, Rinaldo-
dc.contributor.authorHowe, Belinda D-
dc.contributor.authorArabi, Yaseen M-
dc.contributor.authorBailey, Michael-
dc.contributor.authorBass, Frances E-
dc.contributor.authorBin Kadiman, Suhaini-
dc.contributor.authorMcArthur, Colin J-
dc.contributor.authorReade, Michael C-
dc.contributor.authorSeppelt, Ian M-
dc.contributor.authorTakala, Jukka-
dc.contributor.authorWise, Matt P-
dc.contributor.authorWebb, Steve A-
dc.identifier.citationAmerican Journal of Respiratory and Critical Care Medicine 2023; 207(7)en
dc.description.abstractSedation Practice in Intensive Care Evaluation (SPICE-III) trial reported significant heterogeneity in mortality with dexmedetomidine treatment. Supplemental propofol was commonly used to achieve desirable sedation. to quantify the association of different infusion rates of dexmedetomidine or propofol, given in combination, with mortality and if this is modified by age. We included 1177 patients randomized in SPICE-III to receive dexmedetomidine and given supplemental propofol, stratified by age (>65 or ≤65 years). We used double stratification analysis to produce quartiles of steady infusion rates of dexmedetomidine, while escalating propofol dose and vice versa. We used Cox proportional hazard and multivariable regression, adjusted for relevant clinical variable to evaluate the association of sedative dose with 90-day mortality. Younger patients 598/1177(50.8%) received a significantly higher dose of both sedatives compared with older patients, to achieve comparable sedation depth. On double stratification analysis, escalating infusion rates of propofol to 1.27 mg/kg/h at a steady dexmedetomidine infusion rate (0.54 mcg/kg/h) was associated with reduced adjusted mortality in younger, but not older patients. This was consistent with multivariable regression modelling [hazard ratio: 0.59(95% Confidence Interval 0.43-0.78),P<0.0001], adjusted for baseline risk and interaction with dexmedetomidine dose. In contrast, among younger patients using multivariable regression, escalating dexmedetomidine infusion rate was associated with increased adjusted mortality [HR:1.30(95%CI 1.03-1.65), P=0.029]. In patients ≤ 65 years sedated with dexmedetomidine and propofol combination, preferentially increasing the dose of propofol was associated with decreased adjusted 90-day mortality. Conversely, increasing dexmedetomidine may be associated with increased mortality. Clinical trial registration available at www. gov, ID: NCT01728558.en
dc.subjectMechanical ventilation; Sedative effect, Age groups, Intensive Care, Respiratoryen
dc.titleDexmedetomidine and Propofol Sedation in Critically Ill Patients and Dose Associated 90-day Mortality: A Secondary Cohort Analysis of a Randomized Controlled Trial (SPICE-III).en
dc.typeJournal Articleen
dc.identifier.journaltitleAmerican journal of respiratory and critical care medicineen
dc.identifier.affiliationSt John of God Health Care Inc, Intensive Care , Subiaco , Australiaen
dc.identifier.affiliationMonash University Faculty of Medicine Nursing and Health Sciences, ANZIC-RC, Prahran, Victoria, Australiaen
dc.identifier.affiliationIntensive Careen
dc.identifier.affiliationMonash University, ANZIC-RC, Prahran, Victoria, Australiaen
dc.identifier.affiliationANZIC-RC, School of Public Health and Preventive Medicine , Melbourne, Victoria, Australiaen
dc.identifier.affiliationMonash University, School of Clinical Sciences , Clayton, Victoria, Australiaen
dc.identifier.affiliationMonash Health, Intensive Care Services, Clayton, Victoria, Australiaen
dc.identifier.affiliationUniversity of New South Wales - Kensington Campus, Intensive Care - School of Clinical Medicine , Sydney, New South Wales, Australiaen
dc.identifier.affiliationRoyal North Shore Hospital, Intensive Care , St Leonards, New South Wales, Australiaen
dc.identifier.affiliationUniversity of Queensland, Burns, Trauma and Critical Care Research Centre, Brisbane, Queensland, Australiaen
dc.identifier.affiliationAustralian Defence Force, Joint Health Command, Brisbane, Queensland, Australiaen
dc.identifier.affiliationUniversity of Sydney Nepean Clinical School Intensive Care Medicine, Kingswood, New South Wales, Australiaen
dc.identifier.affiliationUniversity of Western Australia, Perth, Australiaen
dc.identifier.affiliationRoyal Perth Hospital, Perth, Australiaen
dc.identifier.affiliationKing Saud bin Abdulaziz Medical City for Science and Technology, Intensive Care Medicine, Riyadh, Saudi Arabia..en
dc.identifier.affiliationNational Heart Institute University of Technology Malaysia Cardiovascular Engineering Centre, Johor Bahru, Johor, Malaysia..en
dc.identifier.affiliationAuckland City Hospital, Intensive Care, Auckland, New Zealand..en
dc.identifier.affiliationInselspital University Hospital Bern, Bern, Switzerland..en
dc.identifier.affiliationUniversity Hospital of Wales, Adult Critical Care, Cardiff, United Kingdom of Great Britain and Northern Ireland..en
dc.identifier.pubmedid36215171-, Rinaldo
item.fulltextNo Fulltext-
item.openairetypeJournal Article- Care- Analytics Research and Evaluation (DARE) Centre- Care- Analytics Research and Evaluation (DARE) Centre-
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