biostudies-literatureUnknown334(1)Walsh TS<h4>Importance</h4>Whether α2-adrenergic receptor agonist-based sedation, compared with propofol-based sedation, reduces time to extubation in patients receiving mechanical ventilation in the intensive care unit (ICU) is uncertain.<h4>Objective</h4>To evaluate whether dexmedetomidine- or clonidine-based sedation reduces duration of mechanical ventilation compared with propofol-based sedation (usual care).<h4>Design, setting, and participants</h4>Pragmatic, open-label randomized clinical trial conducted at 41 ICUs in the UK including adults who were within 48 hours of starting mechanical ventilation, were receiving propofol plus an opioid for sedation and analgesia, and were expected to require mechanical ventilation for 48 hours or longer. The median time from intubation to randomization wJAMA32-45https://www.ebi.ac.uk/biostudies/studies/S-EPMC12090071biostudies-literatureDexmedetomidine- or Clonidine-Based Sedation Compared With Propofol in Critically Ill Patients: The A2B Randomized Clinical Trial.PMC12090071Singleton JWeir CJHumphrey CHajela SSLittle MRaobaikady RPochiraju RElston KElbehery MMartir GGordon ACBanach DVoralia SWalker LRussell AMughal ACockrell MWylie KParker RAYoung PSanders GYoung RKemp LFrawley ADigby BOcean NStorey IKemp HFinn SFaulds MHernandez Morano EMKemp IYoung NCalder VHealey RRhodes JBartlett LDocherty AEdwardson SSowersby JMiller JWaugh VLone NShankar Mde'Ath YBenham LAndrew RNewell CHutchinson JMcCoy ARoss SWaite AMcCulloch CGillespie RSankar VSelman GJenkins SClarey EWhite CRalston MGulati AWalls LWong JQuinn TMorton HGallagher LWishart MParks MDoverman KJanssen DLuen Goh JTeixeira SJepson ELythgoe CWest SSymons LWoodman-Bailey AO'Dwyer CSalmon KHarrison MAWalton CHagan SHusain AMurray CBoyd JManes SJardine CKotrikova NNalk KReece-Anthony RCarter MAmamio MBroderick ABall JMacGregor FSharma SPolley GNoble HChillingworth ASanusi IGarcia PMills JDunn LAmareihe CDunn MCheng LCLant SIqbal SKeil MO'Reilly KOrlikowska IEngelhard CDevine MAlmafreji IForrest MJohnson RAnderson TWeir CNordin NBabio-Galan MJordan HGrowcott MBirrell DSmyth DProwle JAbbas SWhitehead NBromilow JMcAuley JHayley DMartin AKefala KKydonaki KMcConnell PWorner RBonnici JBravoelvira CMcCaffrey JLodhi LHowcroft CLone NIWhiteley SPappa EConway DAhmed SSundaram RVergara BDolan HBello HStewart KMedhurst LHunter ASparkes SMcClatchey AOwen ATan HEHanison JHendrie EGogineni Venkateskara PFallon KDoble PHutton PStambach TPage VJohnston BRollings AConway Morris ARose BOHailstone JTurley CMorenikeji AWalsh TSHays CBroom RLloyd KQuayle RCreagh-Brown BIbrahim MCox TThomas CFaulkner BShaw DThomas AFordyce SPurvis STuck SThomas ECole JCarlota Mahiya MAKinsella MJama RMcLennan GFaulkner MThomas IThomas MTomlin MNorris 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PPatel STaylor CWright CImam LReyes AMorera Vas KSlevin ZVarley JPatel VEager MHu AHales DMcGlynn DRojo RKadr MSrilastava PBriton KDepante MMohammed AGibson JMorrison SYee Chung CBirch SReschrieter HWilliams SBolger CStevenson SDarjee CBewley JKelly SDangol SBirch JJones EPhipps WMacdonald LStevenson MMusselbrook WD'Amato FZhao XOglesby KChuavilong KPatch SHuntley MOwusu-Afriyie JMorgan MPNoor MHDonnelly DJhanji SDonnelly CTopiwala UMacdonald AWebb ZAdlam MBlackmore HLangridge EGillan DMathew SPurnell RTatham KStickle DBaird AKhatun SLubbock SMorley OGlen RParkinson DReeves ERidler SGreen JShilston JEdmunds LGhosh RMires LN'Dungu TBenington SBlunt MBakare SFundano NConner Now Hughes LHoxha EKosifidou EBalmer MKomolafe OSavage JPeters CShackleton RMcNeil MHay AMehta RValcher MMcGuckin EBlaney MPipira LMeddings CSavage SMacLullich AReay MParker NParker LMcCullagh IPage VJGoff EHunt EGui JDaniel EHill HWatkin DFarrah HBashyal AParipoorani DMunnelly SGrimmer LAbel LRoffe SFernandes EWilkinson TSicat CCardwell AKeegan JRaman VVJones KGibbins MBercades GNeep AVentura VSukumaran AArias SSMacCallum NLim RRyan LMansfield OHayes KNorrie JHolden FNutt CMuir AWesterman TAddari CMorris LBeer SSantra TBrealey DWalsh TLongley AAppleton RAntcliffe DWatts SBaillie KJackson SHussey JCendreda BBorislavova BMorris TThompson RAllan ECollins EReid KIrvine SPutnam HCowden RPattison NPenrose RIvison AWilby ELingeswaran SDavies AShelton JNoris IWilson SYong SYHellyer TClark MNarayan BWilson JClark AJeffrey HBayliss MHodson KTalbot SKodous MHughes EAxalan MAMcAuley DMirchandani AButler LRyu JOstermann MMoffitt PKanu RWelters IFarina SColeman CCollin IMurphy EEdwards LHirst RHeij RDavies SDavies RHenderson MInnes RBriggs SPlumb BFernandez de Pinedo Artaraz ZDavies MGurung BBeveridge GGresty JMukherjee PClark RDavies GClark SPerkins GDSlater LGendall EMcGuigan PBaigey ARooney KCumpstey AFurness HMcKenzie CCharles HThomson NCordoba MMSaluzzio RPMcKay LWheeler CHeadley PHenderson SHass IQuek JHenderson PEng Hean TMcloughlin LMaliaykal CHopkins PBrohi FSimoes FConnaughton EKulandhaisamy DSherwood WSalada SSalim NPowell MPrice JTrinh HMelody TCorcoran ESilversides JKennedy-Hay SBold FBurnish RNworah EAckroyd SHowle RSimpson SWilson FJootun RGreenwood JGordon-Williams RSkorko AWoodward ESzakmany TLoew CMeredith MGurung ATMcAuley DFCamsooksai JBarclay LJennings MBrown BMilic VRace PKubanova BBarker MLowe BBannard-Smith JAndreou PFernandez Roman JPlummer NAitken LMTrott SAlicino VHolbrook SGemmell LGlazebrook THope DBrooks JWhiteford IPreller JMajor EOchiltree JJoshy AMGarland ZWellsted DGriffith DShiel RKolovou ALeng VMusalagani RPark DMathews MPerez Guillotin SBeresford SPower KZadeh RSJoseph TFinney CArnott ADevaraja APollard CDickinson SAngel HLeaver SSahni ADing LTempleton MEmerson LDark PLoftus SLonsdale EBiggers RChawla VMoubarak MElsheikh RAdell VRose LSim MBaddeley ACampbell STahir SNunn KMcLaren BBegbie RGiddings ACrossan JHardaker OMcAvoy DLiang YHJoseph AFord DBrown RfalseDexmedetomidine- or Clonidine-Based Sedation Compared With Propofol in Critically Ill Patients: The A2B Randomized Clinical Trial.<h4>Importance</h4>Whether α2-adrenergic receptor agonist-based sedation, compared with propofol-based sedation, reduces time to extubation in patients receiving mechanical ventilation in the intensive care unit (ICU) is uncertain.<h4>Objective</h4>To evaluate whether dexmedetomidine- or clonidine-based sedation reduces duration of mechanical ventilation compared with propofol-based sedation (usual care).<h4>Design, setting, and participants</h4>Pragmatic, open-label randomized clinical trial conducted at 41 ICUs in the UK including adults who were within 48 hours of starting mechanical ventilation, were receiving propofol plus an opioid for sedation and analgesia, and were expected to require mechanical ventilation for 48 hours or longer. The median time from intubation to randomization w2025-01-01T00:00:00Z2025 Jul2026-06-06T17:31:40.623Z2026-06-03T03:10:46.07ZS-EPMC120900714038891610.1001/jama.2025.7200