Critical analysis of the “Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis” study.
This assignment is worth 60 points—6 points per question.
Your clinical facility currently uses primarily propofol for sedation of critically ill patients. A study published in The New England Journal of Medicine in February 2021 compared the use of dexmedetomidine vs propofol for light sedation in mechanically ventilated patients with sepsis as dexmedetomidine has some anti-inflammatory effects. You have been selected as the person to see what the evidence supports and to make a recommendation.
Here is the PICO/Clinical Question based on this scenario:
P/population/problem: ventilated adults with sepsis
I/Intervention: light sedation with dexmedetomidine
O/outcome: improved patient outcomes, such as days alive without delirium or ventilator free days
PICO/Clinical Question: In mechanically ventilated adults with sepsis, does light sedation with dexmedetomidine or propofol lead to better outcomes such as days alive without delirium/coma or ventilator free days?
Use the MAARIE framework questions below to evaluate the study and generate an answer for your facility.
Method- The purpose and population for the investigation
1. Study population What specific population is being investigated and what are the inclusion and exclusion criteria for the subjects of the investigation? Your answer should NOT include information about the randomization process.
Assignment- Selection of participants for the study and control groups
Are the participants and/or the investigators aware of the participants’ assignment to a particular study or control group? If the groups aren’t blinded look for some statement about an independent reviewer or group of reviewers who will evaluate the data collected by the study. It is not simply enough to answer this is a double-blind study (for example)—provide evidence (more than just “the authors say”) to support your answer.
Assessment- Measurement of outcomes or endpoints in the study and control groups
3. Accurate and precise
How will the outcomes selected be accurately and precisely measured? Remember that the focus of this question in the MAARIE framework is to identify the process that will be used to accurately and precisely measure the selected outcomes. A correct answer will include specific descriptions about HOW the primary and secondary outcomes will be measured. In other words, the focus of your answer should not be listing the outcomes.
Results – Comparison of outcomes in the study and control groups
This statement is from page 5 of this study: “Similarly, we found no significant differences between the dexmedetomidine and propofol groups in the number of deaths at 90 days (81 patients [38%] vs. 82 patients [39%]; hazard ratio, 1.06; 95% CI, 0.74 to 1.52).
4. Explain what a hazard ratio (HR) of 1.06 means specific to this study’s results.
To answer this question do more than just “generically” explain what a HR of 1.06 means — explain it in the context of this study.
5. What is the correct interpretation of the CI of 0.74-1.52 in the statement above? When answering this question:
a) Demonstrate that you understand what a 95% CI means,
b) evaluate whether the CI range include the value of no effect/no difference and let me know you understand if zero or one is the value of no effect,
c) Explain what a CI of 0.74-1.52 means – what does this specifically mean in the context of this study?
d) The authors did not report a p-value for the CI range of 0.74-1.52. If the p-value was reported, would it be greater than (>) 0.05 or less than (