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To the Editor: Dr Pandharipande and colleagues¹ studied the effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients and found that the use of dexmedetomidine infusion resulted in more days alive without delirium or coma and more time at the targeted level of sedation. However, because of the lorazepam dosing strategy we believe that the results of this trial have limited generalizability.

Clinical practice guidelines give preference to intravenous push (or bolus dosing) of lorazepam and recommend that continuous lorazepam infusions only be used in patients who require frequent intravenous push doses.² Acutely agitated patients should be given bolus doses initially in addition to increasing the rate of the infusion.² However, in this study all patients received lorazepam as a continuous infusion, and agitated patients were not able to receive lorazepam boluses. The use of a continuous infusion has been associated with an increase . . . [Full Text of this Article]

Bryan Dotson, PharmD
bryan.dotson@utoledo.edu

Michael J. Peeters, PharmD
University of Toledo Medical Center
Toledo, Ohio

RELATED ARTICLE

Effect of Sedation With Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients: The MENDS Randomized Controlled Trial
Pratik P. Pandharipande, Brenda T. Pun, Daniel L. Herr, Mervyn Maze, Timothy D. Girard, Russell R. Miller, Ayumi K. Shintani, Jennifer L. Thompson, James C. Jackson, Stephen A. Deppen, Renee A. Stiles, Robert S. Dittus, Gordon R. Bernard, and E. Wesley Ely
JAMA. 2007;298(22):2644-2653.
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RELATED LETTERS

Sedation With Dexmedetomidine vs Lorazepam in Mechanically Ventilated Patients
Hannah Wunsch and Joseph S. Meltzer
JAMA. 2008;299(13):1540-1541.
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Sedation With Dexmedetomidine vs Lorazepam in Mechanically Ventilated Patients
Jeffrey F. Barletta and John W. Devlin
JAMA. 2008;299(13):1541-1542.
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Sedation With Dexmedetomidine vs Lorazepam in Mechanically Ventilated Patients—Reply
Pratik P. Pandharipande, Timothy D. Girard, and E. Wesley Ely
JAMA. 2008;299(13):1542.
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