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MENDS2 – Dexmedetomidine vs Propofol – Which Is Better?

March 31, 2021

Written by Clay Smith

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For light sedation in patients with sepsis on the ventilator, there was no difference in outcome or safety between dexmedetomidine and propofol.

Why does this matter?
Both dexmedetomidine (dex) or propofol are recommended for sepsis patients on the ventilator. Dex may have some benefit in reducing infection risk over propofol. The authors thought dex might be better. Were they right?

Dex vs milk-of-amnesia
This was a RCT with 422 sepsis patients who were mechanically ventilated and randomized to dex (0.2-1.5 μg/kg/hr) or propofol (5-50 μg/kg/min). For the primary outcome of days alive without delirium or coma over the 14 days of the study, there was no difference in median days 10.7 dex vs. 10.8 propofol; OR 0.96 (95%CI 0.74 to 1.26). There was also no difference in secondary outcomes of ventilator-free days or 90-day mortality. There were no safety differences either.

Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis. N Engl J Med. 2021 Feb 2. doi: 10.1056/NEJMoa2024922. Online ahead of print.

What are your thoughts?