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https://hdl.handle.net/2440/132996
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dc.contributor.author | Shehabi, Y. | - |
dc.contributor.author | Serpa Neto, A. | - |
dc.contributor.author | Howe, B.D. | - |
dc.contributor.author | Bellomo, R. | - |
dc.contributor.author | Arabi, Y.M. | - |
dc.contributor.author | Bailey, M. | - |
dc.contributor.author | Bass, F.E. | - |
dc.contributor.author | Kadiman, S.B. | - |
dc.contributor.author | McArthur, C.J. | - |
dc.contributor.author | Reade, M.C. | - |
dc.contributor.author | Seppelt, I.M. | - |
dc.contributor.author | Takala, J. | - |
dc.contributor.author | Wise, M.P. | - |
dc.contributor.author | Webb, S.A. | - |
dc.contributor.author | Mashonganyika, C. | - |
dc.contributor.author | McKee, H. | - |
dc.contributor.author | Tonks, A. | - |
dc.contributor.author | Donnelly, A. | - |
dc.contributor.author | Hemmings, N. | - |
dc.contributor.author | O’Kane, S. | - |
dc.contributor.author | et al. | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | Intensive Care Medicine, 2021; 47(4):455-466 | - |
dc.identifier.issn | 0342-4642 | - |
dc.identifier.issn | 1432-1238 | - |
dc.identifier.uri | https://hdl.handle.net/2440/132996 | - |
dc.description.abstract | Purpose To quantify potential heterogeneity of treatment effect (HTE), of early sedation with dexmedetomidine (DEX) compared with usual care, and identify patients who have a high probability of lower or higher 90-day mortality according to age, and other identified clusters. Methods Bayesian analysis of 3904 critically ill adult patients expected to receive invasive ventilation > 24 h and enrolled in a multinational randomized controlled trial comparing early DEX with usual care sedation. Results HTE was assessed according to age and clusters (based on 12 baseline characteristics) using a Bayesian hierarchical models. DEX was associated with lower 90-day mortality compared to usual care in patients > 65 years (odds ratio [OR], 0.83 [95% credible interval [CrI] 0.68–1.00], with 97.7% probability of reduced mortality across broad categories of illness severity. Conversely, the probability of increased mortality in patients ≤ 65 years was 98.5% (OR 1.26 [95% CrI 1.02–1.56]. Two clusters were identified: cluster 1 (976 patients) mostly operative, and cluster 2 (2346 patients), predominantly non-operative. There was a greater probability of benefit with DEX in cluster 1 (OR 0.86 [95% CrI 0.65–1.14]) across broad categories of age, with 86.4% probability that DEX is more beneficial in cluster 1 than cluster 2. Conclusion In critically ill mechanically ventilated patients, early sedation with dexmedetomidine exhibited a high probability of reduced 90-day mortality in older patients regardless of operative or non-operative cluster status. Conversely, a high probability of increased 90-day mortality was observed in younger patients of non-operative status. Further studies are needed to confirm these findings. | - |
dc.description.statementofresponsibility | Yahya Shehabi, Ary Serpa Neto, Belinda D. Howe, Rinaldo Bellomo, Yaseen M. Arabi, Michael Bailey ... et al. | - |
dc.language.iso | en | - |
dc.publisher | Springer Science and Business Media | - |
dc.rights | © 2021 Crown | - |
dc.source.uri | http://dx.doi.org/10.1007/s00134-021-06356-8 | - |
dc.subject | Dexmedetomidine; sedation; mechanical ventilation; mortality; critically ill | - |
dc.subject.mesh | Humans | - |
dc.subject.mesh | Critical Illness | - |
dc.subject.mesh | Dexmedetomidine | - |
dc.subject.mesh | Hypnotics and Sedatives | - |
dc.subject.mesh | Respiration, Artificial | - |
dc.subject.mesh | Bayes Theorem | - |
dc.subject.mesh | Adult | - |
dc.subject.mesh | Aged | - |
dc.subject.mesh | Intensive Care Units | - |
dc.title | Early sedation with dexmedetomidine in ventilated critically ill patients and heterogeneity of treatment effect in the SPICE III randomised controlled trial | - |
dc.type | Journal article | - |
dc.identifier.doi | 10.1007/s00134-021-06356-8 | - |
dc.relation.grant | NHMRC | - |
pubs.publication-status | Published | - |
dc.identifier.orcid | Williams, P. [0000-0002-3948-5573] | - |
Appears in Collections: | Medicine publications |
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