A2B

Alpha-2-agonists for sedation to produce better outcomes from critical illness: A randomised, parallel-group, allocation concealed, controlled, open, phase 3 pragmatic clinical and cost- effectiveness

PICO Question

  • Population: Ventilated patients within 48 hours of initiation of mechanical ventilation

  • Interventions: Clonidine ± opioid analgesic or Dexmedetomidine ± opioid analgesic

  • Comparison: Usual care sedation with propofol ± opioid analgesic

  • Outcome: Time from randomisation to successful extubation

Recruitment

Inclusion criteria

Exclusion criteria

  • Aged ≥18

  • Requiring ventilation

  • Within 48 hours of first episode of ventilation in ICU

  • Requiring sedation with propofol

  • Expected to require >48 hours of MV

  • Expected to require >24 hours of MV at the time of randomisation

  • Acute brain injury

  • Post-cardiac arrest

  • Status epilepticus

  • Continuous NMB at the time of screening/randomisation

  • Guillain-Barre Syndrome

  • Myasthenia gravis

  • Home ventilation

  • Fulminant hepatic failure

  • Not expected to survive 24 hours

  • Palliative or end-of-life care

  • Pregnancy

  • Known allergy to study drugs

  • Heart rate <50 for >60mins since ventilated

  • Untreated 2nd/3rd degree heart block

  • Transferred from another ICU where ventilated >6 hours hours

  • Prisoners

  • Enrolled on another CTIMP

  • Previously enrolled on the A2B Trial

Details

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