Dexmedetomidine for sedation during noninvasive ventilation in COVID-19 patients from the Helmet-COVID randomized clinical trial post-hoc analysis

and degree of hypercapnia were largely comparable between both groups. During the ICU stay, dexmedetomidine-treated patients were more likely to have received helmet NIV (70 of 107, 65.4%), awake proning (45 of 107, 42.1%), vasopressors and renal replacement therapy (57.9 and 17.8%, respectively). Dexmedetomidine-treated patients had higher ICU and hospital mortality, higher intubation rate, and fewer ICU-free days compared to those not receiving dexmedetomidine; differences that could not be fully explained by confounding alone. There were no significant differences in HRQoL outcomes at 180 days. Median EQ-5D-5L index values and EQ-VAS median scores showed no significant differences between the dexmedetomidine and non-dexmedetomidine groups. Among patients with COVID-19-induced acute hypoxemic respiratory failure managed with NIV, dexmedetomidine use was common. Dexmedetomidine-treated patients had a different disease trajectory than non-dexmedetomidine-treated patients. The worse outcomes observed with dexmedetomidine were not entirely explained by differences in baseline characteristics, suggesting effects of time-varying confounders. Randomized controlled trials are required to assess effects of dexmedetomidine on patient-centered outcomes.Trial registration: NCT04477668; registered on July 20, 2020.