Is dexmedetomidine a silver bullet for ventilator weaning?

The role of dexmedetomidine in removing intensive care patients from mechanical ventilation was a topic of debate at the 2018 annual congress of the Society of Critical Care Medicine.

The role of dexmedetomidine in removing intensive care patients from mechanical ventilation was a topic of debate at the 2018 annual congress of the Society of Critical Care Medicine. The agent's primary benefits include anxiolysis, morphine-sparing properties, and noninterference with respiratory drive, experts agreed; but it still is not the hands-down top choice among the variety of options available. For one, they noted, it can lead to unfavorable hemodynamic effects; and dexmedetomidine also is much more expensive than benzodiazepines or propofol in this setting. Some of that cost disadvantage is offset, however, by the daily savings achieved by cutting the amount of time patients are ventilated and housed in the ICU. At the same time, while research has suggested that dexmedetomidine outperforms benzodiazepines for extubating ICU patients, there is also evidence that propofol accelerates the process compared with dexmedetomidine—although both have been associated with more ventilator-associated risks than benzodiazepines. Considering the mixed results, "is dexmedetomidine the silver bullet to facilitate extubation?" wonders Gilles Fraser, PharmD, a critical care pharmacist at the Maine Medical Center in Portland. "We use it all the time, but we don't have any firm data." He stresses that care decisions around removal from mechanical ventilation should be based on the patient's individual circumstances.