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To the Editor: The Safety and Efficacy of Dexmedetomidine Compared With Midazolam (SEDCOM) trial by Dr Riker and colleagues¹ compared dexmedetomidine with midazolam as primary sedative medications for mechanically ventilated patients in the intensive care unit (ICU). Patients receiving dexmedetomidine had a lower prevalence of delirium and were extubated almost 2 days earlier than the midazolam group. We believe the safety data from the trial suggest that clinicians should be concerned about using dexmedetomidine in the study's primary patient population, those with severe sepsis.

Three-quarters of the patients in the SEDCOM trial had a diagnosis of severe sepsis. Twenty years ago, a study by Tuchschmidt et al² demonstrated a correlation between increased oxygen delivery and improved survival in patients with septic shock. With contractility and stroke volume routinely compromised in severe sepsis, tachycardia plays an important role in generating the high cardiac output state needed to meet the metabolic demands . . . [Full Text of this Article]

Jack DePriest, MD
jdeprie@conemaugh.org

Luis Gonzalez III, PharmD
Memorial Medical Center
Johnstown, Pennsylvania

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RELATED ARTICLE

Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients: A Randomized Trial
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