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

• Principle investigator: Dan Harvey

• Trainee-lead: Associate PI available!

• DREEAM: Julia Sampson

• Website: https://www.ed.ac.uk/usher/edinburgh-clinical-trials/our-studies/ukcrc-studies/a2b