Dexmedetomidine as a Sedative Agent in Critically Ill Patients: A Meta-Analysis of Randomized Controlled Trials

Abstract

IntroductionThe effect of dexmedetomidine on length of intensive care unit (ICU) stay and time to extubation is still unclear.Materials and MethodsPertinent studies were independently searched in BioMedCentral, PubMed, Embase, and the Cochrane Central Register of clinical trials (updated February first 2013). Randomized studies (dexmedetomidine versus any comparator) were included if including patients mechanically ventilated in an intensive care unit (ICU). Co-primary endpoints were the length of ICU stay (days) and time to extubation (hours). Secondary endpoint was mortality rate at the longest follow-up available.ResultsThe 27 included manuscripts (28 trials) randomized 3,648 patients (1,870 to dexmedetomidine and 1,778 to control). Overall analysis showed that the use of dexmedetomidine was associated with a significant reduction in length of ICU stay (weighted mean difference (WMD) = −0.79 [−1.17 to −0.40] days, p for effect <0.001) and of time to extubation (WMD = −2.74 [−3.80 to −1.65] hours, p for effect <0.001). Mortality was not different between dexmedetomidine and controls (risk ratio = 1.00 [0.84 to 1.21], p for effect = 0.9). High heterogeneity between included studies was found.ConclusionsThis meta-analysis of randomized controlled studies suggests that dexmedetomidine could help to reduce ICU stay and time to extubation, in critically ill patients even if high heterogeneity between studies might confound the interpretation of these results.

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial

“…In line with previous reports, 47 our data showed that dexmedetomidine shortened the duration of mechanical ventilation and the length of ICU stay, and increased the percentage of early hospital discharg e. The previously discussed eff ects produced by dexmedetomidine infusion, including enhanced haemodynamic stability and lowered prevalence of delirium and non-delirium complications, could each contribute to these results. 48 However, our study does not provide causal relationships between the various concurrent outcomes.…”

A web-based survey of United Kingdom sedation practice in the intensive care unit

“…This follows publication of the MIDEX and PRODEX studies demonstrating noninferiority with MDZ and propofol [29]. Comparative sedative cost dictates that dexmedetomidine should be reserved for use in those patients where there is most likely to be benefit [30]. Dexmedetomidine was not included in this sedation survey, although there are plans to include it in the next version.…”

“…It can also avoid the deleterious effects of benzodiazepines. Newer agents such as dexmedetomidine further facilitate awake sedation in a proportion of patients [30].…”

The effect of dexmedetomidine on delirium and agitation in patients in intensive care: systematic review and meta‐analysis with trial sequential analysis

“…Unlike benzodiazepines and opioids, dexmedetomidine is a highly selective and potent α 2 ‐adrenergic agonist . It has a potential role as a sedative agent as it offers the prospect of inducing a calm yet easily rousable state in ICU patients without causing respiratory depression . In addition, it has anxiolytic, analgesic and anti‐inflammatory properties, and may modulate the stress response to illness .…”

“…Dexmedetomidine has also been shown to have organ‐protective effects (neuroprotection, cardioprotection and renoprotection) in non‐cardiac and cardiac surgery . Favourable clinical outcomes of dexmedetomidine in ICU patients are supported by several systematic reviews and meta‐analyses, and include a lower incidence of delirium, and shorter durations of ICU stay and mechanical ventilation . However, most reviews were performed to compare dexmedetomidine with other sedatives (benzodiazepines and opioids); such sedatives may actually increase the incidence of delirium and thus introduce significant response bias .…”