Dexmedetomidine for the prevention of delirium in adults admitted to the intensive care unit or post‐operative care unit: A systematic review of randomised clinical trials with meta‐analysis and Trial Sequential Analysis

Abstract

Objectives: To assess any benefit or harm, we conducted a systematic review of randomised clinical trials (RCTs) allocating adults to dexmedetomidine versus placebo/no intervention for the prevention of delirium in intensive care or post-operative care units.Data Sources: We searched Medline, Embase, CENTRAL and other databases. The last search was 9 April 2022.Data Extraction: Literature screening, data extraction and risk of bias volume 2 assessments were performed independently and in duplicate. Primary outcomes were occurrences of serious adverse events (SAEs), delirium and all-cause mortality.We used meta-analysis, Trial Sequential Analysis, and GRADE (Grading Recommendations Assessment, Development and Evaluation).Data Synthesis: Eighty-one RCTs (15,745 patients) provided data for our primary outcomes. Results from trials at low risk of bias showed that dexmedetomidine may reduce the occurrence of the most frequently reported SAEs (relative risk[RR] 0.69; 95% CI 0.43-1.09), cumulated SAEs (RR 0.70; 95% CI 0.52-0.95) and the occurrence of delirium (RR 0.62; 95% CI 0.43-0.89). The certainty of evidence was very low for delirium. Mortality was very low in trials at low risk of bias (0.4% in the dexmedetomidine groups and 1.0% in the control groups) and meta-analysis did not

Beneficial and harmful effects of tricyclic antidepressants for adults with major depressive disorder: a systematic review with meta-analysis and trial sequential analysis

“…We believe that the present analysis of serious adverse events, a critical outcome of any drug trial, provides useful information regarding the adverse effects of tricyclic antidepressants, and we have assessed serious adverse events using this methodology in several systematic reviews for over a decade. [36][37][38][39][40][41][42][43][44][45][46][47] Still, the above-mentioned limitations should be considered when interpreting our results.…”

“…We used the same systematic approach in all trials, reflecting standard procedures that have been employed in multiple previous reviews. [36][37][38][39][40][41][42][43][44][45][46][47] events according to the ICH-GCP definition, 31 we used the most common serious adverse event for this proportion to potentially avoid double-counting participants with more than one type of serious adverse events.…”

The Impact of Geriatric Conditions in Elderly Patients with Coronary Heart Disease: A State-of-the-Art Review

“…In cases where this is not feasible, dexmedetomidine could be considered [78], as it has been associated with a lower incidence of delirium in the ICU. Caution is advised in its use, particularly in cardiac patients, where a loading dose should be avoided due to potential side effects such as bradycardia, hypotension, and cardiogenic shock [79,80].…”