See the difference

The Facts
Patients requiring Morphine XamdexTM is an alpha2-adrenoreceptor agonist10 - Reduces the sympathetic stress response13,14 - Decreases norepinephrine and epinephrine release - Attenuates stress induced increases in HR and BP 13,14 In clinical trials, significantly fewer patients sedated with Xamdex required morphine analgesia
TM 15

See the difference...

When getting off the ventilator is the goal

100 90 80 70 60 50 40 30 20 10 0

69%
Alm diffe ost 45% renc e

28%

XamdexTM

Propofol

dexmedetomidine HCL
References:
Ref. 1. Maze M, Morrison P. Redefining Sedation. International Congress and Symposium Series. 1998;(221). 2. Guentner K, Hoffman LA, Happ MB, et al. Preferences for mechanical ventilation among survivors of prolonged mechanical ventilation and tracheostomy. Am J Crit Care. 2006;(15):65-77. 3. Chelluri L, Im KA, Belle SH, et al. Long-term mortality and quality of life after prolonged mechanical ventilation. Crit Care Med. 2004;32(1):61-69. 4. Epstein SK. Decision to extubate. Intensive Care Med. 2002;(28):535-546. 5. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;(29):1033-1056. 6. Management of the agitated intensive care unit patient. Crit Care Med. 2002;30(1 suppl management):S97-S123. 7. Arbour R. Using bispectral index monitoring to detect potential breakthrough awareness and limit duration of neuromuscular blockade. Am J Crit Care. 2004;(13):66-73. 8. Epstein J, Breslow MJ. The stress response of critical illness. Crit Care Clin. 1999;(15):17-33. 9. Crippen D. Agitation in the ICU: anatomical and physiologic basis for the agitated state. Crit Care. 1999;(3):R35-R46 10. South African Current approved Package Insert. 11. Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care. 2000;(4):302-308. 12. Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients, A Randomized Trial. JAMA 2009;(301):489-499. 13. Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent). 2001;(14):13-21. 14. Talke P, Richardson CA, Scheinin M, Fischer DM. Postoperative pharmacokinetics and sympatholytic effects of dexmedetomidinel. Anesth Analg. 1997;(85):1136-1142. 15. Herr DL, Sum-Ping STJ, England M. ICU Sedation After Coronary Artery Bypass Graft Surgery: Dexmedetomidine-Based Versus Propofol-Based Sedation Regimens. Journal of Cardiothoracic and Vascular Anesthesia. 2003;(17):576-584. Promo. No: 0009-1210-1638-A-1439 S5 PRECEDEX Dexmedetomidine HCl. Each 1ml of concentrated solution contains dexmedetomidine hydrochloride equivalent to 100 g dexmedetomidine. Reg. No: 34/2.9/0239. For full prescribing information refer to the package insert approved by the Medicines Regulatory Authority. Date of Publication of this Promotional Material: January 2011. Abbott Laboratories S.A. (Pty) Limited, Abbott Place, 219 Golf Club Terrace, Constantia Kloof, 1709. Tel: +27 (11) 858 2000. Fax:+27 (11) 858 2070. www.abbott.com. PIASA Member Company

Xamdex

TM

Sedation Redefined
The challenge
Balancing adequate sedation and patient comfort withthe need to extubate1

The facts
1. Prolonged mechanical ventilation is associated with a higher rate of morbidity and mortality post/after discharge2,3 2. Duration of mechanical ventilation AND use of continuous IV sedatives are two factors associated with a higher prevalence of extubation failure4

The Challenge

See the difference

1

The Facts
Break the cycle with XamdexTM Interrupt the sympathetic response,13,14 maintain patient comfort and facilitate extubation1,10
Length of ICU stay12
8
10

Balancing the need to extubate with sedation and comfort

Test for patients readiness to extubate 4,5,6 Benzodiazepines, propofol and opioids depress mentation and can depress respiration

7.6 days 5.9 days

Alm os diffe t 2 days renc e

Reduction or discontinuation of benzodiazepines, propofol and opioids may be necessary to allow for a successful spontaneous breathing trial (SBT) or institution-specific weaning protocol5,6

Xamdex does not have to be discontinued prior to extubation Xamdex is not associated with respiratory depression
TM 10,11

TM

Length of ICU stay (days)

7 6 5 4 3 2 1

Patient remains on mechanical ventilation; 5 reassess next day Decreasing sedation and analgesia often increases anxiety Failed weaning attempt; and decreases patient comfort6,7

XamdexTM vs Midazolam for sedation of critically ill patients

Prevalence of delirium during treatment12
Prevalence of delirium during treatment (%)
100 90 80 70 60 50 40

Median time to extubation12

7 6 5 4 3 2 1

Failed weaning attempt; and decreases patient comfort6,7 restart sedatives and analgesics

Median time to extubation (days)

5.6 days
Alm os diffe t 2 days renc e

XamdexTM

Midazolam

This increases heart rate and blood pressure, which can create haemodynamic instability7,8,9

This increases potential for agitation6,7 and potential for asynchrony with 6 mechanical ventilation

76.6%
Alm diffe ost 25% renc e

3.7 days

54%

XamdexTM does not have to be discontinued prior to extubation10 XamdexTM facilitates patient comfort before and during extubation

This increases potential for sympathetic stress response and increases epinephrine and norepinephrine levels8,9

XamdexTM

Midazolam

XamdexTM

Midazolam

dexmedetomidine HCI HCL

Xamdex

TM

Sedation Redefined

dexmedetomidine HCL

Xamdex

Adapted from Riker RR, et al12

TM

Sedation Redefined