Dexmedetomidine vs other sedatives in critically ill mechanically ventilated adults: a systematic review and meta-analysis of randomized trials

Lewis, Kimberley; Alshamsi, Fayez; Carayannopoulos, Kallirroi Laiya; Granholm, Anders; Piticaru, Joshua; Duhailib, Zainab Al; Chaudhuri, Dipayan; Spatafora, Laura; Yuan, Yuhong; Centofanti, John; Spence, Jessica; Rochwerg, Bram; Perri, Dan; Holbrook, Anne; Devlin, John W.; Nishida, Osamu; Honarmand, Kimia; Ergan, Begüm; Khorochkov, Eugenia; Pandharipande, Pratik; Alshahrani, Mohammed; Karachi, Tim; Soth, Mark; Shehabi, Yahya; Møller, Morten Hylander; Alhazzani, Waleed

doi:10.1007/s00134-022-06712-2

Cited by 77 publications

(63 citation statements)

References 86 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, multimodal sedation should be used to allow easy titration towards light and optimal sedation, and to reduce the adverse events of individual agents. Timely introduction of specific agents that may promote weaning, reduce agitation and delirium will facilitate early weaning and liberation from mechanical ventilation [ 38 ]. Moreover, new insights in relation of sedation with personalized care may be provided by trials evaluating the efficacy of patient-controlled sedation to manage symptoms associated with the distress induced by mechanical ventilation [ 39 ].…”

Section: Overcoming Sedation Challengesmentioning

confidence: 99%

The future of intensive care: delirium should no longer be an issue

et al. 2022

Self Cite

View full text Add to dashboard Cite

In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A–F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a ‘home-like’ (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.

show abstract

Section: Overcoming Sedation Challengesmentioning

confidence: 99%

The future of intensive care: delirium should no longer be an issue

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…A fim de diminuir a morbimortalidade causada por essa síndrome, é essencial que um agente sedativo livre de delirium faça parte da rotina nas unidades de terapia intensiva. Segundo estudos, a dexmedetomidina parece ter relação com a prevenção do delirium nos pacientes adultos que necessitam de ventilação mecânica (LEWIS et al, 2022;PEREIRA et al, 2020).…”

Section: Resultsunclassified

“…O cloridrato de dexmedetomidina, cujo mecanismo de ação é baseado na ativação do receptor 𝛼-2 pré-sináptico com diminuição da liberação de noradrenalina nas sinapses noradrenérgicas e produção de sedação e hipnose ao interferir na ativação do córtex através do locus ceruleus, tem sido associado à melhora da capacidade de despertar do paciente, preservação do desempenho cognitivo e redução do risco de depressão respiratória. Entretanto, seu uso pode levar a uma resposta da pressão arterial bifásica dose-dependente, com doses mais baixas levando à hipotensão e bradicardia e, as mais altas, relacionam-se com a hipertensão (LEWIS et al, 2022;HEYBATI et al, 2022;PEREIRA et al, 2020).…”

Section: Resultsunclassified

See 1 more Smart Citation

Dexmedetomidina versus outros sedativos na prevenção de Delirium nos adultos em ventilação mecânica

Aquino¹,

Castro²,

Sakuda³

et al. 2023

Braz. J. Develop.

View full text Add to dashboard Cite

Delirium é uma síndrome neurocognitiva aguda relativamente comum e grave que se caracteriza por desatenção, consciência alterada, disfunção cognitiva e curso flutuante, e pode levar à mortalidade, declínio funcional, institucionalização e demência, com maior incidência nos pacientes mais velhos. Pacientes hospitalizados na Unidade de Terapia Intensiva (UTI) e em uso de ventilação mecânica (VM), quando sedados em excesso, possuem maior duração de permanência na UTI, aumento da duração da VM, maior incidência de delirium e mortalidade. Estudos apontam que a dexmedetomidina reduz a incidência de delirium em pacientes adultos hospitalizados na UTI e em uso de ventilação mecânica quando comparada com outros sedativos. Desse modo, o objetivo do estudo é comparar a dexmedetomidina e outros sedativos na prevenção de delirium nos adultos em ventilação mecânica. Trata-se de uma revisão bibliográfica integrativa, do tipo quantitativa, que utilizou as plataformas do PubMed, SciELO e Cochrane Library como bases de dados para seleção dos artigos, todos na língua inglesa. Foram utilizadas literaturas publicadas com recorte temporal de 2017 a 2022. De acordo com as literaturas analisadas, conclui-se que, quando comparado com outros sedativos gabaminérgicos, como os benzodiazepínicos e o propofol, a dexmedetomidina diminui significativamente a incidência de delirium nos pacientes adultos em ventilação mecânica na UTI, com melhora da capacidade de despertar do paciente, preservação do desempenho cognitivo e redução do risco de depressão respiratória. Desse modo, pesquisas futuras sobre as propriedades farmacológicas da dexmedetomidina podem ajudar a determinar se esta droga possui propriedades neuroprotetoras intrínsecas, sendo assim, tal descoberta facilitaria o desenvolvimento de análogos com menos efeitos colaterais cardiorrespiratórios, tendo em vista seu efeito hemodinâmico, com bradicardia e possível hipotensão associadas.

show abstract

“…Several studies use dexmedetomidine as an adjuvant and spinal anesthetics alone or in combination with other drugs but minimal systematic reviews and meta-analyses. Further, these meta-analyses have generally focused on its use as a sedative agent in critically ill patients [ 7 - 8 ]. So, this study was undertaken to combine the results from these studies to evaluate whether combining dexmedetomidine with bupivacaine has a statistically significant effect on its efficacy and safety.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review and Meta-analysis of Efficacy and Safety of Dexmedetomidine Combined With Intrathecal Bupivacaine Compared to Placebo

Kumar¹,

Choudhury²,

Varikasuvu³

et al. 2022

Cureus

View full text Add to dashboard Cite

Background: Dexmedetomidine has been approved as a sedative agent in critical patients. It is also frequently used as an adjuvant with local anesthetic in spinal anesthesia. However, its use as an adjuvant has not been approved due to the paucity of data. The present systematic review and meta-analysis were undertaken to synthesize evidence for efficacy and safety when dexmedetomidine is combined with bupivacaine in spinal anesthesia.Methods: A literature search was done using PubMed, Google Scholar, Embase, and Cochrane Library. Search results were screened and eligible studies were included to perform a systematic review and meta-analysis using the software 'Review Manager (RevMan) version 5.4.1' using a random effect model. Cochrane's' Risk of Bias tool (RoB2)' was used for quality assessment. Mean and standard deviation was used to calculate the standardized mean difference and its forest plot for efficacy measures. For the adverse event, a number of events were used to determine the risk ratio and its forest plot using RevMan software. Publication bias is visualized using a funnel plot.Results: A total of 21 randomized control trials evaluating the efficacy and safety of intrathecal dexmedetomidine were included in the meta-analysis. A total of 1382 participants was included in this meta-analysis. The effect estimates for efficacy parameters, i.e. duration of the sensory block having SMD 2.33; CI, 1.83-2.83, motor block with SMD 1.83, CI 1.21, 2.46, and analgesia SMD 2.81; CI, 2.11-3.51. The risk ratio for adverse effects, i.e. nausea/vomiting, bradycardia, hypotension was not significant whereas it was significant for the incidence of shivering with RR 0.38; CI 0.23-0.97. The overall risk of bias among included studies was either of 'some concern' or 'high risk.' Conclusions: Intrathecal dexmedetomidine when combined with bupivacaine was found to significantly increase the three efficacy parameters, i.e. duration of sensory block, motor block, and analgesia. It also appears to be safe with no increased risk of bradycardia or hypotension. It is also associated with decreased postoperative shivering.

show abstract

Dexmedetomidine vs other sedatives in critically ill mechanically ventilated adults: a systematic review and meta-analysis of randomized trials

Cited by 77 publications

References 86 publications

The future of intensive care: delirium should no longer be an issue

The future of intensive care: delirium should no longer be an issue

Dexmedetomidina versus outros sedativos na prevenção de Delirium nos adultos em ventilação mecânica

A Systematic Review and Meta-analysis of Efficacy and Safety of Dexmedetomidine Combined With Intrathecal Bupivacaine Compared to Placebo

Contact Info

Product

Resources

About