Trial reportCritical care (London, England)2022
Sequential use of midazolam and dexmedetomidine for long-term sedation may reduce weaning time in selected critically ill, mechanically ventilated patients: a randomized controlled study.
Trial report in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02528513 (Midazolam Used Alone or Sequential Use of Midazolam and Propofol/Dexmedetomidine for Long-Term Sedation in Critically Ill, Mechanically Ventilated Patients), which is not on this map. Cited by 17 papers, 5 of them syntheses that pooled it.
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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.
Midazolam Used Alone or Sequential Use of Midazolam and Propofol/Dexmedetomidine for Long-Term Sedation in Critically Ill, Mechanically Ventilated Patients: a Prospective, Randomized Study
Who cites it
17 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- 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
- Efficacy and safety of midazolam versus dexmedetomidine in mechanically ventilated intensive care unit patients: a systematic review and meta-analysis.Frontiers in pharmacology · 2026Pooled it
- Dexmedetomidine for delirium prevention in adult patients following cardiac surgery: a meta-analysis of randomized controlled trials.Journal of cardiothoracic surgery · 2025Pooled it
- Propofol and survival: an updated meta-analysis of randomized clinical trials.Critical care (London, England) · 2023Pooled it
- Pooled it
- Association of Serum Sodium Levels and Delirium in Patients with Sepsis: A Retrospective Study.Biomedicines · 2026Article
- Effects of dexmedetomidine on respiratory and hemodynamic changes in patients receiving high-flow nasal cannula: A retrospective observational study.The Journal of international medical research · 2026Observational
- Dexmedetomidine's Role in Adult ICU After 20 Years of Experience-A Narrative Review.Healthcare (Basel, Switzerland) · 2025Review
- Parental presence in the pediatric intensive care unit reduces postoperative sedative requirements: A retrospective study.World journal of clinical pediatrics · 2025Article
- The Role of Anesthesia in Sedation and Weaning From Mechanical Ventilation: A Systematic Review.Cureus · 2025Review
- Propofol, Triglycerides, and Acute Pancreatitis: A Multicenter Epidemiologic Analysis.Annals of the American Thoracic Society · 2025Observational
- Association of NR1I2 Polymorphism with Midazolam Clearance in Mechanically Ventilated ICU Patients: A Population Pharmacokinetic and Pharmacogenetic Study.Drug design, development and therapy · 2025Article
- Risk Factors of Delirium Following Reconstructive Surgery for Head and Neck Tumors: A Retrospective Clinical Trial.Therapeutics and clinical risk management · 2025Article
- Dexmedetomidine accelerates photoentrainment and affects sleep structure through the activation of SCNCommunications biology · 2024Article
- Challenges in Transitioning from Controlled to Assisted Ventilation in Acute Respiratory Distress Syndrome (ARDS) Management.Journal of clinical medicine · 2024Article
- Ciprofol prevents ferroptosis in LPS induced acute lung injury by activating the Nrf2 signaling pathway.BMC pulmonary medicine · 2024Article
- Article
Corrections and comments
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Authors and funding
18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCurrent sedatives have different side effects in long-term sedation. The sequential use of midazolam and dexmedetomidine for prolonged sedation may have distinct advantages. We aimed to evaluate the efficacy and safety of the sequential use of midazolam and either dexmedetomidine or propofol, and the use of midazolam alone in selected critically ill, mechanically ventilated patients.
methodsThis single-center, randomized controlled study was conducted in medical and surgical ICUs in a tertiary, academic medical center. Patients enrolled in this study were critically ill, mechanically ventilated adult patients receiving midazolam, with anticipated mechanical ventilation for ≥ 72 h. They passed the spontaneous breathing trial (SBT) safety screen, underwent a 30-min-SBT without indication for extubation and continued to require sedation. Patients were randomized into group M-D (midazolam was switched to dexmedetomidine), group M-P (midazolam was switched to propofol), and group M (sedation with midazolam alone), and sedatives were titrated to achieve the targeted sedation range (RASS - 2 to 0).
resultsTotal 252 patients were enrolled. Patients in group M-D had an earlier recovery, faster extubation, and more percentage of time at the target sedation level than those in group M-P and group M (all P < 0.001). They also experienced less weaning time (25.0 h vs. 49.0 h; HR1.47, 95% CI 1.05 to 2.06; P = 0.025), and a lower incidence of delirium (19.5% vs. 43.8%, P = 0.002) than patients in group M. Recovery (P < 0.001), extubation (P < 0.001), and weaning time (P = 0.048) in group M-P were shorter than in group M, while the acquisition cost of sedative drug was more expensive than other groups (both P < 0.001). There was no significant difference in adverse events among these groups (all P > 0.05).
conclusionsThe sequential use of midazolam and dexmedetomidine was an effective and safe sedation strategy for long-term sedation and could provide clinically relevant benefits for selected critically ill, mechanically ventilated patients.
trial registrationNCT02528513 . Registered August 19, 2015.
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