Effect of dexmedetomidine on delirium during sedation in adult patients in intensive care units: A systematic review and meta-analysis

Wang, Shuo; Hong, Yishun; Li, Shiyong; Kuriyama, Akira; Zhao, Yilin; Hu, Jinqian; Luo, Ailin

doi:10.1016/j.jclinane.2020.110157

Cited by 16 publications

(11 citation statements)

References 69 publications

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“… 28 , 29 Effects of dexmedetomidine on delirium in ICU patients has been studied extensively and many studies have shown that dexmedetomidine may reduce the risk of delirium compared to other sedatives. 5 , 30 There is also evidence that dexmedetomidine may reduce the duration of mechanical ventilation and ICU stay, but on the other hand hemodynamic effects of dexmedetomidine limit its use and may even increase the risk for adverse events. 28 The antidelirium effect of dexmedetomidine in CV19 patients remains to be evaluated.…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamic and respiratory effects of dexmedetomidine sedation in critically ill Covid‐19 patients: A retrospective cohort study

Uusalo

Valtonen

Järvisalo

2021

Acta Anaesthesiol Scand

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Introduction Dexmedetomidine has been suggested to be a promising sedative for patients with Covid‐19 infection (CV19). However, use of dexmedetomidine is limited by its heart rate (HR) and arterial blood pressure lowering effects. Moreover, CV19 is associated with cardiac manifestations including bradyarrythmias. The hemodynamic effects of dexmedetomidine have not been previously studied in CV19 patients. We evaluated the effects of dexmedetomidine on hemodynamic and respiratory parameters of CV19 patients. Methods In this single center study, all CV19 patients receiving dexmedetomidine for sedation during a one year period were included. Our primary outcomes included changes in HR, mean arterial pressure (MAP), respiratory rate (RR), partial oxygen pressure of arterial blood/fraction of inspired oxygen‐ratio (PF‐ratio), and Richmond Agitation and Sedation Score (RASS) during dexmedetomidine administration. Results We identified 39 patients with a mean (SD) age of 58.3 (12.7) years. After initiation of dexmedetomidine, HR decreased by 16.9 (3.3) beats/min (95% CI 9.5–22.4; p < 0.001). During the 12‐hour follow‐up period, HR decrease was significant at 2 to 12 h. Incident bradycardia (<45/min) was reported in 12 (30.8%) patients and it was associated with lower plasma C‐reactive protein, Pro‐calcitonin, and troponin T levels. There was no change in MAP compared to baseline. Dexmedetomidine administration was associated with improvement of PF‐ratio ( p < 0.001) and with decrease of RASS ( p = 0.004). Conclusions Dexmedetomidine is an effective sedative for CV19 patients and may improve their oxygenation. However, dexmedetomidine administration is associated with marked decline in HR and with a high incidence of bradycardia in patients with CV19.

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Section: Discussionmentioning

confidence: 99%

“…Delirium has been shown to be common and associated with mortality in patients hospitalized with CV19 28,29 . Effects of dexmedetomidine on delirium in ICU patients has been studied extensively and many studies have shown that dexmedetomidine may reduce the risk of delirium compared to other sedatives 5,30 28 …”

Section: Discussionmentioning

confidence: 99%

Hemodynamic and respiratory effects of dexmedetomidine sedation in critically ill Covid‐19 patients: A retrospective cohort study

Uusalo

Valtonen

Järvisalo

2021

Acta Anaesthesiol Scand

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“…Although the use of a sedative dose of dexmedetomidine (0.2–1.4 μg/kg/hour, with or without a loading dose) in critically ill patients is likely associated with a reduced risk of delirium, higher incidences of bradycardia and hypotension are also found [ 29 , 30 ]. To obtain the effect of postoperative delirium prevention and simultaneously avoid adverse events, low-dose dexmedetomidine was investigated in patients after surgery [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of low-dose dexmedetomidine for prevention of postoperative delirium after intracranial operations: a pilot randomized controlled trial

Cheng

Duan

et al. 2021

BMC Neurol

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Background Clinical trials have shown that dexmedetomidine might decrease the occurrence of postoperative delirium after major surgery, but neurosurgical patients were excluded from these studies. We aimed to determine the feasibility of conducting a full-scale randomized controlled trial of the effect of prophylactic low-dose dexmedetomidine on postoperative delirium in patients after elective intracranial operation for brain tumors. Methods In this single-center, parallel-arm pilot randomized controlled trial, adult patients who underwent an elective intracranial operation for brain tumors were recruited. Dexmedetomidine (0.1 μg/kg/hour) or placebo was continuously infused from intensive care unit (ICU) admission on the day of surgery until 08:00 AM on postoperative day one. Adverse events during the study-drug administration were recorded. The primary feasibility endpoint was the occurrence of study-drug interruption. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU during the first five postoperative days. The assessable rate of delirium evaluation was documented. Results Sixty participants were randomly assigned to receive either dexmedetomidine (n = 30) or placebo (n = 30). The study-drug was stopped in two patients (6.7%) in the placebo group due to desaturation after new-onset unconsciousness and an unplanned reoperation for hematoma evacuation and in one patient (3.3%) in the dexmedetomidine group due to unplanned discharge from the ICU. The absolute difference (95% confidence interval) of study-drug interruption between the two groups was 3.3% (− 18.6 to 12.0%), with a noninferiority P value of 0.009. During the study-drug infusion, no bradycardia occurred, and hypotension occurred in one patient (3.3%) in the dexmedetomidine group. Dexmedetomidine tended to decrease the incidence of tachycardia (10.0% vs. 23.3%) and hypertension (3.3% vs. 23.3%). Respiratory depression, desaturation, and unconsciousness occurred in the same patient with study-drug interruption in the placebo group (3.3%). Delirium was evaluated 600 times, of which 590 (98.3%) attempts were assessable except in one patient in the placebo group who remained in a coma after an unplanned reoperation. Conclusions The low rate of study-drug interruption and high assessable rate of delirium evaluation supported a fully powered trial to determine the effectiveness of low-dose dexmedetomidine on postoperative delirium in patients after intracranial operation for brain tumors. Trial registration The trial was registered at ClinicalTrials.gov (NCT04494828) on 31/07/2020.

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“…12,31,32 Dexmedetomidine was not significantly associated with NCDs in this cohort and even appeared to provide potential protection against delirium among adults on mechanical ventilators. 12,33 Besides, the targeted sedation level of dexmedetomidine was not different from that of midazolam in ICU patients; dexmedetomidine-treated patients experienced less delirium. 32 Interestingly, in previous findings on sleep disturbance, dexmedetomidine is known to stimulate natural sleep and improve sleep quality, 34 which are potentially advantageous for preventing NCDs in ICU patients with sleep disturbance, owing to the two-way relationship between sleep disturbance and major NCDs.…”

Section: Model Performancementioning

confidence: 96%

“…There were significant differences in all vital signs (all p < 0.001). Notably, patients in NCDs group had lower creatinine levels (1.4 (0.9-1.7) vs. 1.6 (1.0-1.6), p < 0.001), potassium levels (4.1 (3.9-4.1) vs. 4.3 (4.0-4.6), p < 0.001), and glucose levels (123 (102-127) vs. 125 (111-130), p < 0.001); shorter partial thromboplastin time (34.7 (27.6-36.9) vs. 36.9 (28.3-36.9), p = 0.006) and international normalized ratio (1.6 (1.2-1.8) vs. 1.6 (1.2-2.0), p < 0.001); higher blood urea nitrogen levels (26 (17-29) vs. 24 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), p = 0.002), hemoglobin levels Moreover, the NCDs group had higher SAPSII scores (36 (31-45) vs. 35 (32)(33)(34)(35)(36)(37)(38)(39), p < 0.001) and SOFA scores (9 (3-10) vs. 6 (3-9), p < 0.001), while lower GCS (14 (12)(13)(14)(15) vs. 15 , p < 0.001) values as compared to the non-NCDs group. Baseline characteristics and details at first admission to ICU for all participants are shown in Table 1.…”

Section: Statistical Analysesmentioning

confidence: 99%

Development and validation of prediction models for neurocognitive disorders in adult patients admitted to the ICU with sleep disturbance

Zhao

Wang

et al. 2021

CNS Neurosci Ther

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Effect of dexmedetomidine on delirium during sedation in adult patients in intensive care units: A systematic review and meta-analysis

Cited by 16 publications

References 69 publications

Hemodynamic and respiratory effects of dexmedetomidine sedation in critically ill Covid‐19 patients: A retrospective cohort study

Hemodynamic and respiratory effects of dexmedetomidine sedation in critically ill Covid‐19 patients: A retrospective cohort study

Feasibility of low-dose dexmedetomidine for prevention of postoperative delirium after intracranial operations: a pilot randomized controlled trial

Development and validation of prediction models for neurocognitive disorders in adult patients admitted to the ICU with sleep disturbance

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