Authors' objectives: Optimising comfort and ability to communicate for mechanically ventilated intensive care unit patients is a priority for clinicians, intensive care unit patients and their relatives. Current usual care is propofol-based sedation plus an opioid analgesic. The alpha2-agonists dexmedetomidine and clonidine are potential alternative sedatives. To explore whether nurses and relatives perceive patients sedated with dexmedetomidine and/or clonidine appear more awake, comfortable and co-operative than patients receiving only propofol-based sedation.

Authors' results and conclusions: Nurse responses were available for > 90% of trial patients [mean (standard deviation) 12 (12) care periods per patient]. Comparing dexmedetomidine versus propofol groups, the odds ratio for a ‘yes’ response to ‘communicate pain’ was 1.38 (95% confidence interval 1.08 to 1.75), and for clonidine versus propofol, it was 1.13 (0.89 to 1.43). For ‘co-operate with care’ comparing dexmedetomidine versus propofol groups, the odds ratio was 1.14 (95% confidence interval 0.98 to 1.32), and for clonidine versus propofol, it was 0.96 (95% confidence interval 0.83 to 1.12). Relative responses were available for 32–34% of trial patients across groups [mean (standard deviation) 3 (3) days per patient]. For the ‘appear awake’ question, the dexmedetomidine versus propofol group odds ratio was 1.48 (95% confidence interval 1.04 to 2.10), and for clonidine versus propofol, it was 1.35 (95% confidence interval 0.95 to 1.91). For ‘appear comfortable’, the dexmedetomidine versus propofol group odds ratio was 0.64 (95% confidence interval 0.38 to 1.09), and for clonidine versus propofol, it was 0.78 (95% confidence interval 0.45 to 1.34). For the ‘feel they can communicate’ comparison, the dexmedetomidine versus propofol group odds ratio was 1.00 (95% confidence interval 0.68 to 1.47), and for clonidine versus propofol, it was 1.05 (95% confidence interval 0.71 to 1.54). Nurses perceived patients receiving dexmedetomidine-based sedation could better communicate pain than with propofol-based sedation, and relatives perceived patients appeared more awake. No differences for the other questions were found, or for the clonidine versus propofol comparisons, although some uncertainty remains due to the wide confidence intervals.

Authors' methods: Substudy within an open-label, three-arm trial. Forty-one intensive care units in the United Kingdom. One thousand four hundred and thirty-seven adults receiving propofol ± opioid for sedation-analgesia within 48 hours of starting mechanical ventilation, expected to require ≥ 48 total hours of mechanical ventilation. Light sedation was targeted in all patients unless clinicians requested deeper sedation. In intervention groups, algorithms promoted alpha2-agonist up-titration and propofol down-titration, followed by sedation primarily with allocated alpha2-agonist. Usual care was propofol-based sedation. Intervention continued until patients were successfully extubated (primary outcome), or other pre-defined end points. Interventions were unblinded, with risk of bias; missing data may not have been at random.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hta/16/93/01

Year Published: 2026

URL for published report: https://www.journalslibrary.nihr.ac.uk/hta/published-articles/GJTW2718

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/GJTW2718

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk