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To the Editor: For the randomized trial of dexmedetomidine vs midazolam for sedation of critically ill patients by Dr Riker and colleagues,¹ the US Food and Drug Administration (FDA) approved dexmedetomidine for up to 30 days of mechanical ventilation. The authors reported no death related to dexmedetomidine when administered at doses greater than 1.4 µg/kg per hour for days in a cohort of patients who were predominately (276/366, 75%) in severe sepsis.

There are 2 safety concerns about the use of dexmedetomidine in this study. First, the authors noted significant incidence of bradycardia (103/244, 42%) in patients treated with dexmedetomidine. Hemodynamic compensation for bradycardia by increasing the stroke volume and systemic vascular resistance are often impaired in patients with severe sepsis.² The use of inotropic and vasopressor medications may be necessary to maintain hemodynamic stability in these patients. The study did not report whether there were any differences in dosing . . . [Full Text of this Article]

Mohamed Y. Rady, MD, PhD
rady.mohamed@mayo.edu

Bhavesh M. Patel, MD; Joel S. Larson, MD
Department of Critical Care Medicine
Mayo Clinic Hospital
Phoenix, Arizona

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