Critical Illness: SPICE III (Sedation Practice in Intensive Care Evaluation )

Question 1

SPICE III Clinical Q

Answer 1

In critically ill adult patients undergoing mechanical ventilation, does the use of dexmedetomidine as the primary sedative as compared to usual care with other sedatives, lead to improvements in mortality?

Question 2

SPICE III Bottom Line

Answer 2

Among patients undergoing mechanical ventilation, primary use of dexmedetomidine as compared to usual care with other sedatives led to more adverse events without improving mortality.

Question 3

SPICE III Primary Outcome

Answer 3

90-day mortality

Question 4

SPICE III Inclusion Criteria

Answer 4

• Age ≥18 years
• Receiving mechanical ventilation through an endotracheal tube
• Expected to receive ventilatory support beyond the next full calendar day
• Receiving sedatives for safety and comfort

Question 5

SPICE III Criticisms

Answer 5

1. Open-label design may have allowed treatment bias
2. Daily sedation vacation was not mandated by the trial
3. Other aspects of critical care was not assessed and may have introduced confounders in the outcomes
4. Sleep was assessed by subjective patient questionnaires instead of polysomnography
5. Adverse events not specified or collected systematically or adjudicated by the trial, reported independently by site investigators

Question 6

Why did they think dexmedetomidine would be better for sedation

Answer 6

providing analgesia without depressing respiratory drive, may produce lighter sedation, and may cause delirium less frequently than other agents.

Question 7

SPICE III Inclusion Criteria

Answer 7

1. Dexmedetomidine - Infusion of dexmedetomidine 1-1.5 mcg/kg/h, with add-on propofol if needed.
   Midazolam to be avoided.
   2.Usual care - Administration of propofol, midazolam, or both as determined by the treating clinician.