Dexmedetomidine to Reduce Vasopressor Resistance in Refractory Septic Shock: α2 Agonist Dexmedetomidine for REfractory Septic Shock (ADRESS): A Double-Blind Randomized Controlled Pilot Trial
- stopped early
- Inclusions stopped early because of higher mortality in the dexmedetomidine arm
Authors' conclusion
Patients in the dexmedetomidine arm had a significantly lower response to phenylephrine at all study times including baseline, which might have contributed to higher early mortality in the dexmedetomidine arm and preclude to conclude on dexmedetomidine efficacy in refractory septic shock.
Study context
- Population
- Mechanically ventilated patients with refractory septic shock (Sepsis-3; norepinephrine ≥0.25 µg/kg/min with persistent circulatory failure), 5 ICUs in Franceof 36 planned
- Participants
- 32 participants
- Comparison
- Dexmedetomidine 1 µg/kg/hr vs placebo
- Primary endpoint
- Arterial pressure response to phenylephrine
- Follow-up
- 6 hours
Methodological detailsmulticentre, placebo-controlled, double-blind, pilot
- Multicentre
- Placebo-controlled
- Double-blind
- Pilot
Primary result
As reported in the abstract
Response to phenylephrine
Dexmedetomidine
1.26
± 0.23
Placebo
1.45
± 0.26
P = 0.048
Further findings
Cumulative norepinephrine dose, lactatemia, SOFA score, fluid balance, ventilation-free days
- No significant differences between groups
Mortality · Day 3; 30 and 90 days
- Higher day-3 mortality with dexmedetomidine; difference diminished and no longer significant at 30 and 90 days
- Inclusions stopped early because of higher mortality in the dexmedetomidine arm
Safety
Bradycardia
- No significant difference between groups
Original publication
Dexmedetomidine to Reduce Vasopressor Resistance in Refractory Septic Shock: α2 Agonist Dexmedetomidine for REfractory Septic Shock (ADRESS): A Double-Blind Randomized Controlled Pilot Trial. Crit Care Med. Published 28 February 2025. doi:10.
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