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Comment & Response |

Dexmedetomidine to Reduce Intubation Time in Patients With Agitated Delirium

Mika Hamilton, MBChB, FRCA, FFICM1; Andre Amaral, MD1
[+] Author Affiliations
1Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
JAMA. 2016;316(7):772-773. doi:10.1001/jama.2016.8599.
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To the Editor Dr Reade and colleagues1 assessed the effect of dexmedetomidine on ventilator-free time in patients with agitated delirium. We have concerns about their definition of outcomes, potential clinician subconscious cognitive biases, and randomization imbalances.

The authors equated the use of tracheostomy and no sedation for 4 hours to an extubation. Because tracheostomies change the clinical course of weaning and delirium, they cannot be analyzed as a success or as a censoring event.2 Clinicians may be inclined to reduce sedatives in patients with tracheostomies because the risk of self-extubation is lower and a tracheostomy contributes less to agitation than an endotracheal tube. A sensitivity analysis considering a tracheostomy as the worst-case scenario or the longest intubation time possible3 would be useful to report.

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August 16, 2016
Michael C. Reade, DPhil, FCICM; Michael Bailey, PhD; Rinaldo Bellomo, MD, FCICM
1Burns, Trauma, and Critical Care Research Centre, University of Queensland, Brisbane, Australia
2Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
3School of Medicine, University of Melbourne, Melbourne, Australia
JAMA. 2016;316(7):773-774. doi:10.1001/jama.2016.8602.
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