CARING FOR THE CRITICALLY ILL PATIENT Dexmedetomidine vs Midazolam or Propofol for SedationDuringProlongedMechanicalVentilation Two Randomized Controlled Trials

SEDATION IN INTENSIVE CARE PAtients is assumed to reduce discomfort from care interventions, increase tolerance of mechanical ventilation, prevent accidental removal of instrumentation, and reduce metabolic demands during cardiovascular and respiratory instability. Long-term sedation may have serious adverse effects, such as prolonged mechanical ventilation, coma, delirium, delusional memories and posttraumatic stress disorder, impaired cognitive function, prolonged hospitalization, increased costs, and mortality. Daily sedation stops, sedation protocols, spontaneous breathing trials and early mobilization, or primary use of opiates without other sedation may help reduce these complications. Current sedatives are problematic in long-term sedation. Benzodiazepines and propofol accumulate unpredictably. High-dose or prolonged propofol use may cause potentially fatal propofol infusion syndrome. Dexmedetomidine, a sedative with high