Effect of intensive care unit sedation strategy on patient‐reported experience: secondary mediation analysis of the A2B randomised controlled trial

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.

The authors' abstract, as published at the source. Anaesthesia, 2026 · DOI ↗