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To the Editor: In their randomized trial, Dr Pandharipande and colleagues¹ concluded that sedation with an infusion of dexmedetomidine resulted in more days alive without delirium or coma and more time at the targeted level of sedation compared with an infusion of lorazepam. However, clinicians should not conclude that use of dexmedetomidine was associated with a decrease in the incidence of ICU delirium given that a combined delirium and coma end point was used to define acute brain dysfunction, and delirium-free days rather than the incidence of delirium at any time during ICU stay was reported. The incidence of delirium at any time in the ICU may be a better predictor of patient outcome than the number of hours that a patient spends in delirium.²

In addition, the article did not present the breakdown of patients who were deemed to have delirium using the disorganized thinking feature of the Confusion . . . [Full Text of this Article]

Jeffrey F. Barletta, PharmD
jeffrey.barletta@spectrum-health.org
Spectrum Health
Grand Rapids, Michigan

John W. Devlin, PharmD
Northeastern University School of Pharmacy
Boston, Massachusetts

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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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Sedation With Dexmedetomidine vs Lorazepam in Mechanically Ventilated Patients
Bryan Dotson and Michael J. Peeters
JAMA. 2008;299(13):1540.
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Sedation With Dexmedetomidine vs Lorazepam in Mechanically Ventilated Patients
Hannah Wunsch and Joseph S. Meltzer
JAMA. 2008;299(13):1540-1541.
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Sedation With Dexmedetomidine vs Lorazepam in Mechanically Ventilated Patients—Reply
Pratik P. Pandharipande, Timothy D. Girard, and E. Wesley Ely
JAMA. 2008;299(13):1542.
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