Mends trial dexmedetomidine

Jump to: navigation , search. In Review. Hughes CG, et al. New England Journal of Medicine. Categories : Reviewable articles Critical Care. Learn more about the modernization effort.

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Federal Government. Read our disclaimer for details. Last Update Posted : September 11, Study Description. Delirium has recently been shown as a predictor of death, increased cost, and longer length of stay in ventilated patients.

Sedative and analgesic medications relieve anxiety and pain, but may contribute to patients' transitioning into delirium. It is possible that modifying the paradigm for sedation using novel therapies targeted at different receptors, such as dexmedetomidine targeting alpha2 receptors and sparing the GABA receptors, could provide efficacious sedation yet reduce the development, duration, and severity of acute brain dysfunction delirium.

Detailed Description:. Specific Aims: to study prevalence and duration of delirium in critically ill patients using differential exposure to alpha2 vs. GABA receptor agonists while evaluating efficacy of sedation and analgesia; to compare clinical outcomes including duration of mechanical ventilation, ICU length of stay and severity of neuropsychological dysfunction at hospital discharge; and to develop pharmacokinetic and pharmacodynamic models for dexmedetomidine and lorazepam when used for up to 5 days in ICU patients.

Drug Information available for: Lorazepam Dexmedetomidine. FDA Resources. Arms and Interventions. Outcome Measures. Primary Outcome Measures : achieving target sedation level [ Time Frame: Patients will receive study drug for a maximum of hours 5 days ] The patients' managing team will set the "goal" or "target" as medically indicated using the RASS Eligibility Criteria.

Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Subjects with advanced heart block at time of screening. Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials. More Information. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. There were no differences in any of the endpoints:. Prior studies have failed to find any definitive winner between the two. Individual patients may nonetheless respond better to one or the other. One peculiarity of the study may limit this conclusion, however. So what is going on?

Why do the American patients receive so much more opioids? In the MENDS2 trial, it appears that fentanyl was often used for its sedative properties rather than its analgesic properties. For example, the study protocol explicitly specifies that fentanyl may be used to provide rescue sedation figure below.

Fentanyl is a potent analgesic but a weak sedative , so if it is being used for its sedative properties then you will need a lot. Alternatively, in the European studies, patients were sufficiently awake to communicate with caregivers regarding pain. When patients were able to communicate the difference between pain and anxiety, it turned out that the actual amount of pain was not very high as reflected in the low morphine requirement.

This suggests that we may often be overestimating the amount of pain that our patients are experiencing. Thus, when high doses of opioids are used to achieve comfort, these drugs may be acting via sedative and euphoric effects — not analgesic effects. Ideally, we should be trying to sort out pain, anxiety, and delirium.

Pain should be treated with analgesics, anxiety with sedatives, and delirium with antipsychotics.