Landmark study evaluating new sedation paradigm in ventilated ICU patients

A study led by Professor Yahya Shehabi, Professor of Medicine and Program Director of Critical Care in the School of Clinical Sciences, evaluated the clinical effectiveness of the non-conventional sedative, dexmedetomidine, given within hours of needing ventilatory support as the primary first line sedative agent.

Each year there are more than 160,000 patients admitted to ICUs around Australia, 80,000 of those receive ventilatory support, and more than 60,000 develop an episode of delirium, a devastating event especially in older Australians.

The NHMRC funded SPICE III Trial evaluated the use of dexmedetomidine in patients receiving ventilatory support for more than 24 hours in 74 ICUs worldwide and recruited 4000 patients, making the study the largest ICU sedation trial ever conducted. Despite being available for over ten years, the use of dexmedetomidine has been as an adjunct sedative drug, mainly used between 4-5 days following the commencement of ventilatory support. In this trial it was used within 5 hours as the primary first line treatment.

Although the overall mortality was similar in both treatment groups, a pre-specified subgroup analysis revealed a significant age dependent divergent mortality effect with lower mortality in patients older than 63 years old and higher mortality in younger adults treated with dexmedetomidine. The trial also showed an increase in the number of days free of ventilatory support and number of days free of coma and delirium.

“These findings are particularly important with the increasing number of older Australians admitted to ICUs. The potential number of lives saved in Australia and worldwide, of older ICU patients, is many thousands per year. The reduction in delirium is very significant in the older patients, who are at significant risk of delirium” Professor Shehabi says.

Professor Shehabi presented the results of SPICE III trial in a JAMA/NEJM dedicated session at the American Thoracic Society International Annual meeting in Dallas on May 19.

The findings have also been published in the New England Journal of Medicineonline first https://www.nejm.org/doi/full/10.1056/NEJMoa1904710