Short summary

30 patients will be randomized either to recieve Dexdor or placebo. PSG (polysomnography) will be done for 16 hours on both groups to determine if sleep quality when sedated with Dexdor is the same or better than when non-sedated and mechanically ventilated in the intensive care unit.

Rationale

Dexmedetomidin (DEX) is a sedative that induces a state of unconsciousness resembling Non-REM sleep (slow wave sleep) (20). The action is reduction of the reticular activation system including thalamus and cortex, but to lesser degree cardio-pulmonary function. This unique site of action lends DEX an equally unique sedative profile, conferring ability to sedate while at the same time allowing patients to interact. As a sedative, DEX is notable for its lack of suppression of the respiratory drive.

Previous data demonstrate that comfort during mecanical ventilation (MV) can be achieved with no or very light sedation, which is associated with lower incidence of delirium and shorter Lengh of Stay  in the ICU. Traditionally sedation during MV has been done with opioids,  benzodiazepines and/or propofol, but accumulation of benzodiazepines can prolong MV, weaning and lengh of stay. Recent guidelines and commentaries have advocated a revision of ICU sedation practices and the adoption of sedation strategies based on non-benzodiazepine sedatives (either propofol or dexmedetomidine) to improve clinical outcomes in mechanically ventilated adult ICU patients. DEX, has been shown to provide good comfort during MV with a good safety profile and reduced time to extubation. One former and smaller study suggest that critically ill patients, treated with DEX during nights showed increased sleep efficiency and improved sleep pattern.

Description of the cohort

Mechanically ventilated patients admitted to intensive care unit.

Data and biological material

Polysomnography will be done time 2 per patient and stored electronically on a server.