Efficacy and safety of sedation with dexmedetomidine in critical care patients: A meta-analysis of randomized controlled trials

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• 作者：Jean-Michel Constantin^a ; ^{jmconstantin@chu-clermontferrand.fr" class="auth_mail" title="E-mail the corresponding author} ; Aurelien Momon^a ; Jean Mantz^c ; Jean-Franç ; ois Payen^d ; ^e ; Bernard De Jonghe^f ; Sebastien Perbet^a ; Sophie Cayot^a ; Gerald Chanques^g ; Bruno Perreira^b
• 关键词：Sedation ; Meta-analysis ; Critical care ; Mechanical ventilation ; Delirium
• 刊名：Anaesthesia Critical Care & Pain Medicine
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：35
• 期：1
• 页码：7-15
• 全文大小：782 K

文摘

Dexmedetomidine may help physicians target a low level of sedation. Unfortunately, the impact of dexmedetomidine on major endpoints remains unclear in intensive care unit (ICU).

Material and methods

To evaluate the association between dexmedetomidine use with efficacy and safety outcomes, two reviewers independently identified randomized controlled trials comparing dexmedetomidine with other sedative agents in non-post-cardiac surgery critically ill patients in the PubMed and Cochrane databases. Random effects models were considered if heterogeneity was detected using the DerSimonian and Laird estimation method. Statistical heterogeneity between results was assessed by examining forest plots, confidence intervals (CI) and by using the I² statistic. The risk of bias was assessed using the risk of bias tool.

Results

This meta-analysis included 1994 patients from 16 randomized controlled trials. Comparators were lorazepam, midazolam and propofol. Dexmedetomidine was associated with a reduction in ICU length of stays (WMD = −0.304; 95% CI [−0.477, −0.132]; P = 0.001), mechanical ventilation duration (WMD = −0.313, 95% CI [−0.523, −0.104]; P = 0.003) and delirium incidence (RR = 0.812, 95% CI [0.680, 0.968]; P = 0.020). Dexmedetomidine is also associated with an increase in the incidence of bradycardia (RR = 1.947, 95% CI [1.387, 2.733]; P = 0.001) and hypotension (RR = 1.264; 95% CI [1.013, 1.576]; P = 0.038).

Conclusions and relevance

In this first meta-analysis including only randomized controlled trials related to ICU patients, dexmedetomidine was associated with a 48 h reduction in ICU length of stay, mechanical ventilation duration and delirium occurrence despite a significant heterogeneity among studies. Dexmedetomidine was also associated with an increase in bradycardia and hypotension.