Effect of intensive care unit sedation strategy on patient-reported experience: secondary mediation analysis of the A2B randomised controlled trial
In brief
ICU patients recalled 3.6 points more awareness with dexmedetomidine than propofol
At 90 days, patients sedated with dexmedetomidine reported greater awareness of their ICU surroundings than those given propofol, a 3.6-point adjusted difference. The strategies were not associated with differences in frightening memories, recall or satisfaction, and only 289 of 1,009 survivors completed the questionnaire. These limited findings do not support choosing dexmedetomidine over propofol to improve patient experience.
- Journal
- Anaesthesia (Q1)
- Published
- 6 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- John A Masterson, Isabella Ritchie, Leanne M Aitken, Bronagh Blackwood, Kalliopi Kydonaki, Cathrine A McKenzie, et al.
- PMID
- 42838510
- DOI
- 10.1111/anae.70437
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 25 October 2026): Sedation strategy impacts patient‑reported ICU experience
Abstract
INTRODUCTION: The optimal ICU sedation strategy to improve patient-reported experience is unknown. In a planned secondary analysis of the A2B randomised trial, we evaluated the effect of sedation strategy (dexmedetomidine, clonidine or propofol) on recalled patient experience at 90 days post-randomisation. Using mediation analyses, we explored plausible mediators of the relationship between sedation strategy and patient experience. METHODS: We analysed data for all patients from A2B who completed the Intensive Care Experience Questionnaire (ICE-Q) at 90 days. The primary outcome was patient-recalled experience, measured by the four ICE-Q domain scores (awareness, frightening memories, recall, satisfaction). Sedation strategy effect was evaluated using linear regression, adjusting for potential confounders. Mediation analyses were conducted for duration of mechanical ventilation; ICU stay; and days with pain behaviour, agitation and coma/delirium. RESULTS: Of 1404 patients included in the primary trial analysis, 1009 (71.9%) were alive at 90 days post-randomisation with ICE-Qs completed by 289/1009 (28.6%). Compared with propofol, dexmedetomidine sedation was associated with higher awareness of surroundings (median score 32 vs. 28, adjusted mean difference 3.6, 95%CI 1.0-6.2, p = 0.01), but clonidine sedation had no association (difference 2.4, 95%CI -0.2-5.0, p = 0.07). No associations were found with other ICE-Q domains. The contribution of the five potential mediators on the dexmedetomidine-awareness relationship was small. DISCUSSION: Dexmedetomidine compared with propofol sedation strategy may be associated with increased recalled awareness of surroundings, which is considered a favourable indicator of ICU experience. Together with the primary A2B trial results, which showed no effect on ventilation duration, these hypothesis-generating findings in a subgroup of the A2B cohort do not support the use of dexmedetomidine over propofol based on patient-reported experience. Based on our findings, we advocate that a personalised approach to sedation strategies should continue to be used.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.