---
title: "Early Dexmedetomidine Added to Propofol Sedation and 28‑Day Mortality in Mechanically Ventilated P"
id: "pubmed-42757774"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42757774"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42757774/"
doi: "10.1177/10600280261478937"
published_at: "2026-09-18T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Early Dexmedetomidine Added to Propofol Sedation and 28‑Day Mortality in Mechanically Ventilated P
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42757774
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42757774/)
- **DOI:** [10.1177/10600280261478937](https://doi.org/10.1177%2F10600280261478937)
- **Published At:** 2026-09-18T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This target trial emulation used the **Medical Information Mart for Intensive Care (MIMIC)** database to compare outcomes when **dexmedetomidine (DEX)** was added early to propofol sedation versus propofol alone in mechanically ventilated adults. - Two treatment strategies were emulated: strategy A—DEX added within 24 hours of propofol initiation and continued ≥4 hours; strategy B—propofol only throughout. - The analysis used a Clone‑Censor‑Weight (CCW) framework to reduce immortal time bias and multivariable Cox regression to assess 28‑day mortality. - The cohort comprised 10,896 mechanically ventilated patients. - Fully adjusted CCW‑Cox models showed early DEX initiation was associated with lower 28‑day mortality (HR 0.663; 95% CI 0.551–0.798; P < .001). - Early DEX was not significantly associated with 7‑day acute kidney injury after full adjustment (P = .163). - Early DEX was associated with higher odds of bradycardia (OR 1.70; 95% CI 1.34–2.13; P < .001) and higher odds of severe hypotension (OR 1.23; 95% CI 1.02–1.48; P = .031). The association with mild hypotension did not reach significance (OR 1.24; 95% CI 0.98–1.60; P = .080). - Authors conclude early DEX added to propofol sedation was associated with reduced 28‑day mortality but increased cardiovascular adverse events; they advise weighing benefits against bradycardia and hypotension risks and call for prospective validation.
## Clinical Analysis & Structured Key Points
Clipboard, Search History, and several other advanced features are temporarily unavailable. [ Skip to main page content ](https://pubmed.ncbi.nlm.nih.gov/42757774/#article-details) ![U.S. flag](https://cdn.ncbi.nlm.nih.gov/coreutils/uswds/img/favicons/favicon-57.png) An official website of the United States government Here's how you know ![Dot gov](https://cdn.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-dot-gov.svg) **The .gov means it’s official.** Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site. ![Https](https://cdn.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-https.svg) **The site is secure.** The **https://** ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. [ ![NIH NLM Logo](https://cdn.ncbi.nlm.nih.gov/coreutils/nwds/img/logos/AgencyLogo.svg) ](https://www.ncbi.nlm.nih.gov/) [Log in](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42757774%2F) Show account info Close #### Account Logged in as: **username** * [Dashboard](https://www.ncbi.nlm.nih.gov/myncbi/) * [Publications](https://www.ncbi.nlm.nih.gov/myncbi/collections/bibliography/) * [Account settings](https://www.ncbi.nlm.nih.gov/account/settings/) * [Log out](https://www.ncbi.nlm.nih.gov/account/signout/?back_url=https%3A//pubmed.ncbi.nlm.nih.gov/42757774/) [Access keys](https://www.ncbi.nlm.nih.gov/guide/browsers/#ncbi_accesskeys) [NCBI Homepage](https://www.ncbi.nlm.nih.gov) [MyNCBI Homepage](https://pubmed.ncbi.nlm.nih.gov/myncbi/) [Main Content](https://pubmed.ncbi.nlm.nih.gov/42757774/#maincontent) [Main Navigation](https://pubmed.ncbi.nlm.nih.gov/42757774/) [ ![pubmed logo](https://cdn.ncbi.nlm.nih.gov/pubmed/c24ab723-7c80-48cd-9c68-022ded852586/core/images/pubmed-logo-blue.svg) ](https://pubmed.ncbi.nlm.nih.gov/) [ ](https://pubmed.ncbi.nlm.nih.gov/42757774/ "Show search bar") Search: [](https://pubmed.ncbi.nlm.nih.gov/42757774/ "Clear search input")Search [Advanced](https://pubmed.ncbi.nlm.nih.gov/advanced/) [ Clipboard ](https://pubmed.ncbi.nlm.nih.gov/clipboard/) [ User Guide ](https://pubmed.ncbi.nlm.nih.gov/help/) Save Email Send to * [ Clipboard ](https://pubmed.ncbi.nlm.nih.gov/42757774/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42757774%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42757774%2F%23open-collections-panel) * [Citation manager](https://pubmed.ncbi.nlm.nih.gov/42757774/) Display options Display options Format Abstract PubMed PMID ## Save citation to file Format: Summary (text) PubMed PMID Abstract (text) CSV Create file Cancel ## Email citation Email address has not been verified. Go to [ My NCBI account settings ](https://account.ncbi.nlm.nih.gov/settings/) to confirm your email and then refresh this page. To: Subject: Body: Format: Summary Summary (text) Abstract Abstract (text) MeSH and other data Send email Cancel ### Add to Collections * Create a new collection * Add to an existing collection Name your collection: Name must be less than 100 characters Choose a collection: Unable to load your collection due to an error [Please try again](https://pubmed.ncbi.nlm.nih.gov/42757774/) Add Cancel ### Add to My Bibliography * My Bibliography Unable to load your delegates due to an error [Please try again](https://pubmed.ncbi.nlm.nih.gov/42757774/) Add Cancel ## Your saved search Name of saved search: Search terms: [Test search terms](https://pubmed.ncbi.nlm.nih.gov/42757774/) Would you like email updates of new search results? Saved Search Alert Radio Buttons * Yes * No Email: ([change](https://www.ncbi.nlm.nih.gov/account/settings/)) Frequency: Monthly Weekly Daily Which day? The first Sunday The first Monday The first Tuesday The first Wednesday The first Thursday The first Friday The first Saturday The first day The first weekday Which day? Sunday Monday Tuesday Wednesday Thursday Friday Saturday Report format: Summary Summary (text) Abstract Abstract (text) PubMed Send at most: 1 item 5 items 10 items 20 items 50 items 100 items 200 items Send even when there aren't any new results Optional text in email: Save Cancel ## Create a file for external citation management software Create file Cancel ## Your RSS Feed Name of RSS Feed: Number of items displayed: 5 10 15 20 50 100 Create RSS Cancel RSS Link Copy ### Actions Cite Collections Add to Collections * Create a new collection * Add to an existing collection Name your collection: Name must be less than 100 characters Choose a collection: Unable to load your collection due to an error [Please try again](https://pubmed.ncbi.nlm.nih.gov/42757774/) Add Cancel Permalink Permalink Copy Display options Display options Format Abstract PubMed PMID ### Page navigation * [ Title & authors ](https://pubmed.ncbi.nlm.nih.gov/42757774/#heading) * [ Abstract ](https://pubmed.ncbi.nlm.nih.gov/42757774/#abstract) * [Similar articles](https://pubmed.ncbi.nlm.nih.gov/42757774/#similar) Title & authors Abstract Similar articles Ann Pharmacother Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ann+Pharmacother%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ann+Pharmacother%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42757774/) . 2026 Sep 18:10600280261478937. doi: 10.1177/10600280261478937. Online ahead of print. # Effect of Early Dexmedetomidine Addition on Prognosis in Mechanically Ventilated Patients Under Propofol Sedation: A Target Trial Emulation Study [Bozhi Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+B&cauthor_id=42757774)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42757774/#full-view-affiliation-1 "Department of Anesthesiology, The First People's Hospital of Foshan, China."), [Meijuan Liao](https://pubmed.ncbi.nlm.nih.gov/?term=Liao+M&cauthor_id=42757774)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42757774/#full-view-affiliation-1 "Department of Anesthesiology, The First People's Hospital of Foshan, China."), [Hanbing Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+H&cauthor_id=42757774)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42757774/#full-view-affiliation-1 "Department of Anesthesiology, The First People's Hospital of Foshan, China.") Affiliations Expand ### Affiliation * 1 Department of Anesthesiology, The First People's Hospital of Foshan, China. * PMID: **42757774** * DOI: [ 10.1177/10600280261478937 ](https://doi.org/10.1177/10600280261478937) Item in Clipboard # Effect of Early Dexmedetomidine Addition on Prognosis in Mechanically Ventilated Patients Under Propofol Sedation: A Target Trial Emulation Study Bozhi Zhang et al. Ann Pharmacother. 2026. Show details Display options Display options Format Abstract PubMed PMID Ann Pharmacother Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ann+Pharmacother%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ann+Pharmacother%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42757774/) . 2026 Sep 18:10600280261478937. doi: 10.1177/10600280261478937. Online ahead of print. ### Authors [Bozhi Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+B&cauthor_id=42757774)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42757774/#short-view-affiliation-1 "Department of Anesthesiology, The First People's Hospital of Foshan, China."), [Meijuan Liao](https://pubmed.ncbi.nlm.nih.gov/?term=Liao+M&cauthor_id=42757774)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42757774/#short-view-affiliation-1 "Department of Anesthesiology, The First People's Hospital of Foshan, China."), [Hanbing Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+H&cauthor_id=42757774)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42757774/#short-view-affiliation-1 "Department of Anesthesiology, The First People's Hospital of Foshan, China.") ### Affiliation * 1 Department of Anesthesiology, The First People's Hospital of Foshan, China. * PMID: **42757774** * DOI: [ 10.1177/10600280261478937 ](https://doi.org/10.1177/10600280261478937) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Combination propofol-dexmedetomidine (DEX) therapy may affect patient prognosis. However, it remains unknown whether the effects of this combination depend on the timing of DEX initiation. **Objective:** This study aimed to investigate the association between early initiation of DEX and mortality in mechanically ventilated patients receiving propofol sedation. **Methods:** This study was based on the Medical Information Mart for Intensive Care database. Two strategies were established via target trial emulation: strategy A, in which DEX was added within 24 hours of propofol initiation and maintained for ≥4 hours; strategy B, in which only propofol was used throughout the treatment period. The Clone-Censor-Weight (CCW) framework was applied to eliminate immortal time bias; multivariate Cox regression was performed to evaluate 28-day mortality. Weighted logistic regression was applied to evaluate safety outcomes such as 7-day acute kidney injury (AKI), bradycardia, and hypotension, followed by exploratory subgroup analyses. **Results:** Among 10 896 patients, fully adjusted CCW-Cox regression revealed that early initiation of DEX was associated with a lower risk of 28-day mortality (hazard ratio [HR] = 0.663, 95% confidence interval [CI], 0.551-0.798, _P_ < .001). Fully adjusted logistic regression indicated that early initiation of DEX was not significantly associated with the odds of developing AKI within 7 days (_P_ = .163). Early DEX initiation was associated with higher odds of bradycardia (odds ratio [OR] = 1.70, 95% CI, 1.34-2.13, _P_ < .001) and severe hypotension (OR = 1.23, 95% CI, 1.02-1.48, _P_ = .031). The association with mild hypotension did not reach statistical significance (OR = 1.24, 95% CI, 0.98-1.60, _P_ = .080). **Conclusion and relevance:** In mechanically ventilated patients receiving propofol sedation, early initiation of DEX was associated with a reduced risk of 28-day mortality but increased odds of bradycardia and severe hypotension. These findings indicate that the potential benefits of early DEX use should be carefully weighed against its cardiovascular safety risks in clinical practice. Further prospective studies are warranted to validate the present results. **Keywords:** Medical Information Mart for Intensive Care; dexmedetomidine; mechanical ventilation; propofol. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Alpha2 agonists for sedation to produce better outcomes for adults with critical illness: a synopsis of the A2B RCT with cost-effectiveness and process evaluation. ](https://pubmed.ncbi.nlm.nih.gov/42384077/) Walsh TS, Parker RA, Aitken LM, Emerson L, McKenzie CA, Boyd J, MacDonald A, Beveridge G, Giddings A, Hope D, Irvine S, Tuck S, Lone NI, Kydonaki K, Norrie J, Creagh-Brown B, McAuley DF, Dark P, Wise MP, Gordon AC, Perkins GD, Reade MC, Blackwood B, MacLullich A, Glen R, Page VJ, Morris S, Weir CJ.Walsh TS, et al.Health Technol Assess. 2026 Jun;30(48):1-94. doi: 10.3310/GJTW3820.Health Technol Assess. 2026.PMID: 42384077Free PMC article.Clinical Trial. * [ Relative and bedside nurse assessment of comfort and communication during propofol, dexmedetomidine, or clonidine-based sedation: pre-planned analysis within the A2B RCT. ](https://pubmed.ncbi.nlm.nih.gov/41549569/) Walsh TS, Parker RA, Aitken LM, McKenzie CA, Glen R, Weir CJ.Walsh TS, et al.Health Technol Assess. 2026 Jan;30(48):1-18. doi: 10.3310/GJTW2718.Health Technol Assess. 2026.PMID: 41549569Free PMC article.Clinical Trial. * [ Dexmedetomidine vs. propofol for sedation in mechanically ventilated ICU patients: a systematic review and meta-analysis of randomized controlled trials. ](https://pubmed.ncbi.nlm.nih.gov/42558219/) Zhang XY, Qin S, Liu MJ, Wang YY.Zhang XY, et al.Front Neurol. 2026 Jul 22;17:1875240. doi: 10.3389/fneur.2026.1875240. eCollection 2026.Front Neurol. 2026.PMID: 42558219Free PMC article. * [ Effects of dexmedetomidine versus propofol on outcomes in critically ill patients with different sedation depths: a propensity score-weighted cohort study. ](https://pubmed.ncbi.nlm.nih.gov/39293538/) Wang HC, Huang CJ, Liao SF, Lee RP.Wang HC, et al.Anaesth Crit Care Pain Med. 2024 Dec;43(6):101425. doi: 10.1016/j.accpm.2024.101425. Epub 2024 Sep 16.Anaesth Crit Care Pain Med. 2024.PMID: 39293538 * [ Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients. ](https://pubmed.ncbi.nlm.nih.gov/25879090/) Chen K, Lu Z, Xin YC, Cai Y, Chen Y, Pan SM.Chen K, et al.Cochrane Database Syst Rev. 2015 Jan 6;1(1):CD010269. doi: 10.1002/14651858.CD010269.pub2.Cochrane Database Syst Rev. 2015.PMID: 25879090Free PMC article. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42757774) [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42757774/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42757774%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42757774/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42757774%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42757774%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42757774/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited. Follow NCBI [ Twitter ](https://twitter.com/ncbi) [ Facebook ](https://www.facebook.com/ncbi.nlm) [ LinkedIn ](https://www.linkedin.com/company/ncbinlm) [ GitHub ](https://github.com/ncbi) [ ](https://ncbiinsights.ncbi.nlm.nih.gov/) [Connect with NLM](https://www.nlm.nih.gov/socialmedia/index.html) * [ Twitter ](https://twitter.com/NLM_NIH) * [ SM-Facebook ](https://www.facebook.com/nationallibraryofmedicine) * [ SM-Youtube ](https://www.youtube.com/user/NLMNIH) National Library of Medicine [8600 Rockville Pike Bethesda, MD 20894](https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/@38.9959508,-77.101021,17z/data=!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb:0x19156f88b27635b8!8m2!3d38.9959508!4d-77.0988323) [Web Policies](https://www.nlm.nih.gov/web_policies.html) [FOIA](https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office) [HHS Vulnerability Disclosure](https://www.hhs.gov/vulnerability-disclosure-policy/index.html) [Help](https://support.nlm.nih.gov/?pagename=pubmed%3Apubmed%3Aabstract%3ANONE) [Accessibility](https://www.nlm.nih.gov/accessibility.html) [Careers](https://www.nlm.nih.gov/careers/careers.html) * [NLM](https://www.nlm.nih.gov/) * [NIH](https://www.nih.gov/) * [HHS](https://www.hhs.gov/) * [USA.gov](https://www.usa.gov/)
## Related Clinical Research

- [Monitoring and Dose Adjustment of Regional Citrate Anticoagulation for Continuous Renal Replacemen](https://medichelpline.com/clinical-feed/pubmed-42758964.md) (DOI: 10.1097/MCC.0000000000001433)
- [Artificial Intelligence and Machine Learning in the Transplantation Surgery Care Pathway](https://medichelpline.com/clinical-feed/pubmed-42751007.md) (DOI: 10.5500/wjt.122433)
- [Optical compression of multimodal ICU data into Clinical Visual Memory for generative trajectory f](https://medichelpline.com/clinical-feed/medrxiv-0-optical-compression-of-multimodal-clinical-data-into-a-unified-visual-memory.md)
- [Agentic-TimesFM-AKI: Dual LLM–Time Series System for Predicting Drug-Induced Acute Kidney Injury](https://medichelpline.com/clinical-feed/medrxiv-3-agentic-timesfm-aki-a-dual-llm-time-series-framework-for-predicting-drug.md)
- [Bleeding Reduction in Acute and Chronic Kidney Patients Having Surgery (BRACKETS) Pilot Trial](https://medichelpline.com/clinical-feed/clinicaltrials-nct06337838.md) (DOI: NCT06337838)

## Navigation
- [← Back to Critical Care Feed](https://medichelpline.com/clinical-feed/critical-care.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.