Dexmedetomidine Versus Propofol in the Medical Intensive Care Unit (MICU)

• Mechanical Ventilation
• Critical Illness

• Drug: Dexmedetomidine
  continuous IV infusion 0.2 - 1.5 ucg/kg/hour titrated to target RASS
  Other Name: Precedex
• Drug: Propofol
  continuous IV infusion (5 - 50 ucg/kg/min) titrated to target RASS
  Other Name: Diprivan
• Drug: Fentanyl
  25 - 200 mcg IV every hour (as multiple IV pushes) as needed titrated to Non-Verbal Pain Scale
• Drug: Midazolam
  0.01 - 0.1 mg/kg IV push every 10 minutes as needed for agitation (RASS>+2)
  Other Name: Versed
• Behavioral: Physical and Occupational Therapy
  Daily therapy sessions targeting range of motion, strength, and mobility

• Active Comparator: Dexmedetomidine
  Patients in this arm will receive continuous dexmedetomidine infusion (0.2 - 1.5 mcg/kg/hour) titrated to the target Richmond Agitation Sedation Scale for the duration of mechanical ventilation or 7 days on study, whichever is first.
  Interventions:

  • Drug: Dexmedetomidine
  • Drug: Fentanyl
  • Drug: Midazolam
  • Behavioral: Physical and Occupational Therapy
• Active Comparator: Propofol
  Patients in this arm will receive propofol (5 - 50 mcg/kg/min) for sedation, titrated to the target Richmond Agitation Sedation Scale for the duration of mechanical ventilation or 7 days on study, whichever is first.
  Interventions:

  • Drug: Propofol
  • Drug: Fentanyl
  • Drug: Midazolam
  • Behavioral: Physical and Occupational Therapy

Inclusion Criteria:

• >18 years old
• mechanically ventilated through endotracheal tube
• anticipated need for ventilation > 48 hours
• requiring sedative/analgesic medication

Exclusion Criteria:

• on mechanical ventilator > 96 hours
• primary neurologic disease
• post cardiac arrest
• do not speak English (assessment only English language validated)
• pregnancy or lactation
• active myocardial ischemia
• second or third degree heart block
• pancreatitis
• elevated serum triglycerides (> 400 mg/dL)