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To The Editor: In the MENDS trial, Dr Pandharipande and colleagues¹ concluded that dexmedetomidine infusion resulted in more days alive without delirium or coma and more time at the targeted level of sedation than with a lorazepam infusion. It remains unclear whether the study findings are due to the benefits of dexmedetomidine or are a result of the study design itself.

The trial was designed so that an increase of 1 mL per hour of the unknown drug resulted in an increase of either 0.15 µg per hour in dexmedetomidine or 1.0 mg per hour in lorazepam. These are not equivalent doses of medications, as demonstrated by the reported median infusion rate for dexmedetomidine of 5 mL per hour and, for lorazepam, only 3 mL per hour. Moreover, dexmedetomidine has a much shorter half-life (2-3 hours) compared with lorazepam (10 hours).^2-3

This nonequivalence of drug raises a number of questions. . . . [Full Text of this Article]

Hannah Wunsch, MD, MSc
hw2125@columbia.edu

Joseph S. Meltzer, MD
Department of Anesthesiology
Columbia University College of Physicians and Surgeons
New York, New York

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Effect of Sedation With Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients: The MENDS Randomized Controlled Trial
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