Trial reportCritical care (London, England)2010
Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial.
Trial report in Critical care (London, England), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 5 registered trials, which are not on this map. Cited by 145 papers, 10 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomized, Double-blind Trial in Ventilated ICU Patients Comparing Treatment With an Alpha2 Agonist Versus a Gamma Aminobutyric Acid (GABA)-Agonist to Determine Delirium Rates, Efficacy of Sedation, Analgesia and Discharge Cognitive Status
Multicentric, Single Blind, Randomized Controlled Trial on Enteral Sedation Versus Intravenous Sedation in Critically Ill High-risk ICU Patients
PRO-DEFENSE: Propofol Versus Dexmedetomidine for Sedation in Mechanically Ventilated Patients With Sepsis
Pain, Agitation and Delirium Protocol in Ventilated Patients in the Duke CICU
Investigation of Sleep in the Intensive Care Unit
Who cites it
145 citing papers in PubMed, 10 syntheses or guidelines pooled it, 413 citations in OpenAlex.
- The effect of dexmedetomidine in mechanically ventilated patients with sepsis and septic shock: a meta-analysis of randomized controlled trials.Annals of medicine · 2026Pooled it
- Dexmedetomidine reduces the inflammation level and morality in adult sepsis: a systemic review and meta-analysis based on randomized controlled trials.Frontiers in medicine · 2025Pooled it
- Pooled it
- The Effect of Dexmedetomidine as a Sedative Agent for Mechanically Ventilated Patients With Sepsis: A Systematic Review and Meta-Analysis.Frontiers in medicine · 2021Pooled it
- Effect of Dexmedetomidine on duration of mechanical ventilation in septic patients: a systematic review and meta-analysis.BMC pulmonary medicine · 2020Pooled it
- The effect of dexmedetomidine and clonidine on the inflammatory response in critical illness: a systematic review of animal and human studies.Critical care (London, England) · 2019Pooled it
- Efficacy of dexmedetomidine for treatment of patients with sepsis: A meta-analysis of randomized controlled trials.Medicine · 2019Pooled it
- Interventions for preventing delirium in hospitalised non-ICU patients.The Cochrane database of systematic reviews · 2016Pooled it
- Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients.The Cochrane database of systematic reviews · 2015Pooled it
- Defining the Role of Dexmedetomidine in the Prevention of Delirium in the Intensive Care Unit.BioMed research international · 2015Pooled it
- Alpha2 agonists for sedation to produce better outcomes for adults with critical illness: a synopsis of the A2B RCT with cost-effectiveness and process evaluation.Health technology assessment (Winchester, England) · 2026Trial
- Do financial constraint and perceived stress modify the effects of food tax schemes on food purchases: moderation analyses in a virtual supermarket experiment.Public health nutrition · 2024Trial
- Nocturnal dexmedetomidine alleviates post-intensive care syndrome following cardiac surgery: a prospective randomized controlled clinical trial.BMC medicine · 2021Trial
- Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis.The New England journal of medicine · 2021Trial
- The influence of dexmedetomidine and propofol on circulating cytokine levels in healthy subjects.BMC anesthesiology · 2019Trial
- Trial
- The influence of analgesic-based sedation protocols on delirium and outcomes in critically ill patients: A randomized controlled trial.PloS one · 2017Trial
- Dexmedetomidine versus morphine infusion following laparoscopic bariatric surgery: effect on supplemental narcotic requirement during the first 24 h.Surgical endoscopy · 2016Trial
- Corticosteroids and transition to delirium in patients with acute lung injury.Critical care medicine · 2014Trial
- Enteral vs. intravenous ICU sedation management: study protocol for a randomized controlled trial.Trials · 2013Trial
85 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Erratum issued
Authors and funding
10 authors at 7 institutions in 2 countries.
Funding
Abstract
introductionBenzodiazepines and alpha2 adrenoceptor agonists exert opposing effects on innate immunity and mortality in animal models of infection. We hypothesized that sedation with dexmedetomidine (an alpha2 adrenoceptor agonist), as compared with lorazepam (a benzodiazepine), would provide greater improvements in clinical outcomes among septic patients than among non-septic patients.
methodsIn this a priori-determined subgroup analysis of septic vs non-septic patients from the MENDS double-blind randomized controlled trial, adult medical/surgical mechanically ventilated patients were randomized to receive dexmedetomidine-based or lorazepam-based sedation for up to 5 days. Delirium and other clinical outcomes were analyzed comparing sedation groups, adjusting for clinically relevant covariates as well as assessing interactions between sedation group and sepsis.
resultsOf the 103 patients randomized, 63 (31 dexmedetomidine; 32 lorazepam) were admitted with sepsis and 40 (21 dexmedetomidine; 19 lorazepam) without sepsis. Baseline characteristics were similar between treatment groups for both septic and non-septic patients. Compared with septic patients who received lorazepam, the dexmedetomidine septic patients had 3.2 more delirium/coma-free days (DCFD) on average (95% CI for difference, 1.1 to 4.9), 1.5 (-0.1, 2.8) more delirium-free days (DFD) and 6 (0.3, 11.1) more ventilator-free days (VFD). The beneficial effects of dexmedetomidine were more pronounced in septic patients than in non-septic patients for both DCFDs and VFDs (P-value for interaction = 0.09 and 0.02 respectively). Additionally, sedation with dexmedetomidine, compared with lorazepam, reduced the daily risk of delirium [OR, CI 0.3 (0.1, 0.7)] in both septic and non-septic patients (P-value for interaction = 0.94). Risk of dying at 28 days was reduced by 70% [hazard ratio 0.3 (0.1, 0.9)] in dexmedetomidine patients with sepsis as compared to the lorazepam patients; this reduction in death was not seen in non-septic patients (P-value for interaction = 0.11).
conclusionsIn this subgroup analysis, septic patients receiving dexmedetomidine had more days free of brain dysfunction and mechanical ventilation and were less likely to die than those that received a lorazepam-based sedation regimen. These results were more pronounced in septic patients than in non-septic patients. Prospective clinical studies and further preclinical mechanistic studies are needed to confirm these results.
trial registrationNCT00095251.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.