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In Reply: Drs DePriest and Gonzalez and Dr Rady and colleagues raise important issues regarding dexmedetomidine and sepsis. Despite their suggestions, our primary population comprised intubated patients requiring sedation, and sepsis was a common associated diagnosis. The Investigational New Drug (IND) application for dexmedetomidine was approved by the FDA for this trial with doses from 0.2 to 1.4 µg/kg per hour (not greater than 1.4 µg/kg) for up to 30 days.

We agree with DePriest and Gonzalez that it is important to maintain adequate oxygen delivery, although data are now clear that targeting supranormal levels for hemodynamic variables in sepsis is not beneficial.¹ While 103 dexmedetomidine-treated patients had bradycardia, 98 of them (95%) met this criterion based on a 30% decrease in heart rate from baseline, and only 12 (12%) required any intervention for bradycardia. In considering the theoretical concerns mentioned by the writers, data from animal models and patients . . . [Full Text of this Article]

Richard R. Riker, MD
rikerr@mmc.org
Maine Medical Center
Portland

Yahya Shehabi, MD
University of New South Wales Clinical School
The Prince of Wales Hospital Campus
Randwick, Australia

Marcelo G. Rocha, MD
Pavilhão Pereira Filho
Irmandade Santa Casa de Misericórdia
Porto Alegre, Brazil

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