Effectiveness of Sedation Strategies in Critically Ill Patients: Dexmedetomidine vs. Propofol

Background: Sedation is essential for critically ill patients requiring mechanical ventilation in the intensive care unit (ICU). Dexmedetomidine and Propofol are commonly used sedative agents with distinct pharmacological profiles. This study aimed to compare the effectiveness and safety of Dexmedetomidine versus Propofol for sedation in critically ill ICU patients. Methods: This prospective randomized comparative study was conducted in the ICU of the Department of Anaesthesiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, over 12 months (June 2023 to May 2024). A total of 84 mechanically ventilated ICU patients were randomly assigned into two groups: Group D (Dexmedetomidine, n=42) and Group P (Propofol, n=42). Sedation quality was assessed using the Richmond Agitation-Sedation Scale (RASS), and hemodynamic parameters were monitored over 48 hours. Primary outcomes included time to achieve target sedation, duration of mechanical ventilation, and ICU stay. Secondary outcomes included incidence of delirium, adverse events, and mortality. Data were analyzed using SPSS version 26.0, with p < 0.05 considered statistically significant. Results: Demographic and baseline clinical characteristics were comparable between the two groups (p > 0.05). Time to achieve target sedation was significantly longer in Group D than in Group P (42.5 ± 11.3 vs. 28.6 ± 9.5 minutes; p < 0.001). Dexmedetomidine provided more pronounced hemodynamic stability, with a significantly lower heart rate at 24 and 48 hours (p < 0.001). The duration of mechanical ventilation (72.5 ± 24.7 vs. 89.6 ± 30.5 hours; p = 0.004) and length of ICU stay (6.8 ± 2.3 vs. 8.4 ± 2.9 days; p = 0.002) were significantly lower in Group D. Dexmedetomidine was associated with a lower incidence of delirium on Day 5 (4.8% vs. 21.4%; p = 0.017). However, bradycardia was more frequent in Group D (21.4% vs. 7.1%; p = 0.046), while respiratory depression was higher in Group P (0% vs. 11.9%; ...