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In Reply: Drs Dotson and Peeters and Drs Wunsch and Meltzer correctly note that the pharmacokinetic properties of continuously infused lorazepam could have contributed to oversedation in the control group of our MENDS trial. However, such moderate to heavy use of sedatives continues to characterize usual practice.^1-2 When designing and conducting a double-blind trial to evaluate dexmedetomidine, which is only administered via continuous infusion, we chose lorazepam as the control group in accordance with the guidelines of the Society of Critical Care Medicine for long-term sedation of ventilated patients.³ Despite the longer half-life of lorazepam, the majority of patients in both groups were sedated at the level targeted by the ICU team. When undersedation or agitation did occur, study drug boluses were not permitted because of potential adverse effects, but the infusions could be increased and fentanyl boluses were used if pain was suspected. In response to Wunsch and Meltzer, . . . [Full Text of this Article]

Pratik P. Pandharipande, MD, MSCI
pratik.pandharipande@vanderbilt.edu
Division of Critical Care
Department of Anesthesiology

Timothy D. Girard, MD, MSCI; E. Wesley Ely, MD, MPH
Division of Pulmonary Critical Care
Department of Medicine
Vanderbilt University
Nashville, Tennessee

RELATED ARTICLE

Effect of Sedation With Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients: The MENDS Randomized Controlled Trial
Pratik P. Pandharipande, Brenda T. Pun, Daniel L. Herr, Mervyn Maze, Timothy D. Girard, Russell R. Miller, Ayumi K. Shintani, Jennifer L. Thompson, James C. Jackson, Stephen A. Deppen, Renee A. Stiles, Robert S. Dittus, Gordon R. Bernard, and E. Wesley Ely
JAMA. 2007;298(22):2644-2653.
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RELATED LETTERS

Sedation With Dexmedetomidine vs Lorazepam in Mechanically Ventilated Patients
Bryan Dotson and Michael J. Peeters
JAMA. 2008;299(13):1540.
EXTRACT | FULL TEXT  

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
Jeffrey F. Barletta and John W. Devlin
JAMA. 2008;299(13):1541-1542.
EXTRACT | FULL TEXT