Dexmedetomidine versus No-sedation for Agitation Control in COPD Patients receiving Noninvasive Ventilation: a Randomized Trial

Abstract Background Agitation occurs in 20–50% of ICU patients and can lead to failure of noninvasive ventilation (NIV). The use of benzodiazepines poses a risk of respiratory depression, which makes dexmedetomidine use in COPD patients a suitable alternative despite its haemodynamic profile. Yet, the available literature provides inconsistent data regarding its efficacy and safety. Aim of work The study aimed to compare ability of dexmedetomidine to control agitation in COPD patients receiving NIV, and to avoid invasive mechanical ventilation (IMV) compared to conservative approaches without using sedation. Methods Agitated COPD patients admitted for NIV (Richmond’s Agitation-Sedation Scale (RASS) ≥ + 2) were randomized to receive either conservative management alone or adding IV dexmedetomidine infusion (0.2–0.7 mcg/kg/wt). Sedation was assessed using RASS at baseline, 1, 2, 12, 24, and 48 h thereafter. Vital signs, Glasgow Coma Scale (GCS), ABGs, and Visual Analogue Scale (VAS) were also documented. The primary outcomes were agitation control (RASS 0 to -2– at 48 h), and NIV success. Secondary outcomes included haemodynamic effects, pain control, ICU mortality, NIV duration and length of stay (LOS) in ICU. Results Ninety-three patients were enrolled into this randomised-controlled trial. Data of 80 patients (39 and 41 in Dexmedetomidine and No-sedation group) were analyzed. The two groups were comparable regarding demographic and baseline clinical characteristics. HR and SBP were comparable throughout the study, while DBP was significantly lower at 12 and 24 h in dexmedetomidine group. Agitation control was more frequent (81.2% vs. 34.1% P < 0.001) and delirium was less frequent (one vs. eight patients, P = 0.029) among Dexmedetomidine recipients. However, no significant differences were observed regarding NIV success ( P = 0.328), ICU mortality ( P = 0.999), NIV duration ( P = 0.086), or LOS in ICU ( P = 0.817). Conclusion For agitated COPD patients receiving NIV, dexmedetomidine could achieve agitation control in a significantly larger number of patients compared to not using a sedative. However, it had no significant effect on NIV success, NIV duration, ICU mortality or LOS. Transient decrease in DBP was observed with dexmedetomidine.