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Comment & Response |

Dexmedetomidine to Reduce Intubation Time in Patients With Agitated Delirium—Reply

Michael C. Reade, DPhil, FCICM1; Michael Bailey, PhD2; Rinaldo Bellomo, MD, FCICM3
[+] Author Affiliations
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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In Reply In the dexmedetomidine trial, there was a significant difference in the unadjusted comparison of the primary outcome, ventilator-free hours at 7 days (median, 145 hours [interquartile range {IQR}, 114-156 hours] vs 128 hours [IQR, 92-143 hours]; P = .01), and after stratification adjustment for site (median between-group difference, 17.0 hours [95% CI, 4.0-33.2 hours]; P = .04). The primary outcome had to account for patients who underwent tracheostomy. Options included equating tracheostomy with extubation (but this would equate failure to extubate with success), excluding patients with tracheostomy (when this was done there was no difference in the significance of the primary outcome), or defining no longer intubated as equivalent to the time after tracheostomy when all sedation opioids were first discontinued for a prolonged period (defined as 4 hours).

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August 16, 2016
Mika Hamilton, MBChB, FRCA, FFICM; Andre Amaral, MD
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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