Efficacy and safety of dexmedetomidine in sepsis patients requiring mechanical ventilation: a systematic review and meta‐analysis

Liu, Zhao; Zeng, Yiqian; Yang, Bihui; Pinhu, Liao

doi:10.1111/jcpt.13548

Cited by 7 publications

(7 citation statements)

References 22 publications

(24 reference statements)

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“…Our outcomes were different from that of several similar previous meta-analyses ( Zhang et al, 2019 ; Chen et al, 2020 ; Huang et al, 2021 ; Wang et al, 2021 ; Abdelazeem et al, 2022 ; Liu et al, 2022 ). Chen et al ( Chen et al, 2020 ) reported that DEX increased the number of ventilator-free days and reduced 28-day mortality for sedation among mechanically ventilated adult sepsis or septic shock patients, and Zhang et al ( Zhang et al, 2019 ) concluded that dexmedetomidine could dramatically reduce 28-day mortality.…”

Section: Discussioncontrasting

confidence: 99%

“…Furthermore, their interventions of the control group were broad, including sedatives such as midazolam and lorazepam. Although four meta-analyses ( Huang et al, 2021 ; Wang et al, 2021 ; Abdelazeem et al, 2022 ; Liu et al, 2022 ) draw the similar primary outcome as we were in the previous year, we believed that our present study was more persuasive than those because of the larger sample size and the more specific control group. As the rigorous eligibility criteria we designed, our present meta-analysis, including 1,212 patients and setting propofol intervention principally for the control group, rendered the results more convincing.…”

Section: Discussionmentioning

confidence: 52%

“…The largest sample size in the rest previous meta-analysis that explicitly adopted propofol as a comparator was 933 patients ( Wang et al, 2021 ) and there were only four trials that reported the short-term mortality. Liu et al ( Liu et al, 2022 ) reported that DEX had no effect on length of ICU stay. However, they only involved five RCTs and their comparison included lorazepam and midazolam.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Dexmedetomidine Versus Propofol in Mechanically Ventilated Patients With Sepsis: A Meta-Analysis of Randomized Controlled Trials

et al. 2022

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Purpose: The aim of the present study was to evaluate the effects of dexmedetomidine compared with propofol in mechanically ventilated patients with sepsis.Methods: We searched PubMed, EMBASE, and Cochrane Library for randomized controlled trials comparing the effects of dexmedetomidine versus propofol in septic patients requiring mechanical ventilation from inception to December 2021. The primary outcome was 28/30-day mortality and secondary outcomes were ventilator-free days and the length of ICU stay. Pooled relative risk (RR), mean deviation (MD), along with 95% confidence intervals (CI) were used to express outcomes by the software of Review Manager 5.3.Results: Seven studies with a total of 1,212 patients were eligible for meta-analysis. The results primarily showed that dexmedetomidine had no significant effects on the 28/30-day mortality (RR = 1.04 [0.85–1.26], p = 0.70, I2 = 3%). As for secondary outcomes, the administration of dexmedetomidine was not associated with longer-ventilator-free days (MD = 0.50 [−2.15, 3.15], p = 0.71, I2 = 24%) compared with propofol. However, our results revealed dexmedetomidine could shorten the length of ICU stay (MD = −0.76 [−1.34, −0.18], p = 0.01, I2 = 33%).Conclusion: Administration of dexmedetomidine for sedation in septic patients who required mechanical ventilation had no effect on 28/30-day mortality and ventilator-free days, but it could shorten the length of ICU stay.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

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Comparison of Dexmedetomidine Versus Propofol in Mechanically Ventilated Patients With Sepsis: A Meta-Analysis of Randomized Controlled Trials

et al. 2022

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“…Several systematic reviews and meta-analyses on this research topic have been previously conducted [ 11 ] [ 12 ] [ 13 ] [ 49 ] [ 14 ]. Among previous meta-analyses, Huang et al was the most comprehensive study [ 13 ], and it included 15 RCTs with 1,871 patients in the analysis.…”

Section: Discussionmentioning

confidence: 99%

Use of dexmedetomidine in patients with sepsis: a systematic review and meta-analysis of randomized-controlled trials

Zhang

Mei

Dai

et al. 2022

Ann. Intensive Care

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Background Dexmedetomidine is widely used in patients with sepsis. However, its effect on septic patients remains controversial. The objective of this study was to summarize all randomized controlled trials (RCTs) examining dexmedetomidine use in sepsis patients. Methods This systematic review and meta-analysis included RCTs comparing dexmedetomidine with other sedatives in adult sepsis patients. We generated pooled relative risks (RRs) and standardized mean differences and performed trial sequential analysis and a cumulative meta-analysis. The primary outcome was mortality, and the secondary outcomes were the length of the intensive care unit stay, duration of mechanical ventilation, number of ventilation-free days, incidence of total adverse event, incidence of delirium, and levels of interleukin 6, tumor necrosis factor alpha, and alanine aminotransferase. Results We included 19 RCTs that enrolled 1929 patients. Compared with other sedatives, dexmedetomidine decreased the all-cause mortality (RR 0.83; 95% confidence interval [CI] [0.69, 0.99]) and inflammatory response (interleukin 6 and tumor necrosis factor alpha levels at 24 h: standardized mean difference (SMD) − 2.15; 95% CI [− 3.25, − 1.05] and SMD − 1.07, 95% CI [− 1.92, − 0.22], respectively). Trial sequential analysis showed that it is not up to required information size. The overall risk adverse events was similar between dexmedetomidine and the other sedatives (RR 1.27, 95% CI [0.69, 2.36]), but dexmedetomidine increased the risk of arrhythmias (RR 1.43, 95% CI [0.59, 3.51]). Length of intensive care unit stay (SMD − 0.22; 95% CI [− 0.85, − 0.41]), duration of mechanical ventilation (SMD 0.12; 95% CI [− 1.10, 1.35]), incidence of delirium (RR 0.98; 95% CI [0.72, 1.33]), and levels of alanine aminotransferase and creatinine at 24 h were not significantly reduced. Conclusions Dexmedetomidine in sepsis patients could significantly reduce mortality compared with benzodiazepines but not with propofol. In addition, dexmedetomidine can significantly decrease inflammatory response in patients with sepsis compared with other sedatives. Dexmedetomidine might lead to an increased incidence of arrhythmias, but its safety profile did not show significant differences in the incidence of total adverse events. Future RCTs are needed to determine the sepsis patient population that would benefit most from dexmedetomidine and its optimal dosing regimen.

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“…It was approved as a short-term (<24 h) sedative agent in 1999, for sedation in non-tracheal intubation patients in 2008, and for sedation during general anesthesia, endotracheal intubation, and mechanical ventilation in 2009 by the U.S. Food and Drug Administration (FDA) ( Paris and Tonner, 2005 ; Bao and Tang, 2020 ). Sedation with dexmedetomidine was associated with shorter durations of mechanical ventilation and intensive care unit (ICU) stay, lower risk of delirium, and better postoperative cognitive function ( Mo and Zimmermann, 2013 ; Buckley et al, 2021 ; Liu et al, 2022 ). The analgesic property was also identified as supplementation to intravenous analgesic, peripheral nerve block, and intrathecal anesthesia ( Schnabel et al, 2013 ; Mohamed et al, 2014 ; Shen et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

A comprehensive overview of clinical research on dexmedetomidine in the past 2 decades: A bibliometric analysis

Kong

Deng

et al. 2023

Front. Pharmacol.

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Introduction: Dexmedetomidine is a potent, highly selective α-2 adrenoceptor agonist with sedative, analgesic, anxiolytic, and opioid-sparing properties. A large number of dexmedetomidine-related publications have sprung out in the last 2 decades. However, no bibliometric analysis for clinical research on dexmedetomidine has been published to analyze hot spots, trends, and frontiers in this field.Methods: The clinical articles and reviews related to dexmedetomidine, published from 2002 to 2021 in the Web of Science Core Collection, were retrieved on 19 May 2022, using relevant search terms. VOSviewer and CiteSpace were used to conduct this bibliometric study.Results: The results showed that a total of 2,299 publications were retrieved from 656 academic journals with 48,549 co-cited references by 2,335 institutions from 65 countries/regions. The United States had the most publications among all the countries (n = 870, 37.8%) and the Harvard University contributed the most among all institutions (n = 57, 2.48%). The most productive academic journal on dexmedetomidine was Pediatric Anesthesia and the first co-cited journal was Anesthesiology. Mika Scheinin is the most productive author and Pratik P Pandharipande is the most co-cited author. Co-cited reference analysis and keyword analysis illustrated hot spots in the dexmedetomidine field including pharmacokinetics and pharmacodynamics, intensive care unit sedation and outcome, pain management and nerve block, and premedication and use in children. The effect of dexmedetomidine sedation on the outcomes of critically ill patients, the analgesic effect of dexmedetomidine, and its organ protective property are the frontiers in future research.Conclusion: This bibliometric analysis provided us with concise information about the development trend and provided an important reference for researchers to guide future research.

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Efficacy and safety of dexmedetomidine in sepsis patients requiring mechanical ventilation: a systematic review and meta‐analysis

Cited by 7 publications

References 22 publications

Comparison of Dexmedetomidine Versus Propofol in Mechanically Ventilated Patients With Sepsis: A Meta-Analysis of Randomized Controlled Trials

Comparison of Dexmedetomidine Versus Propofol in Mechanically Ventilated Patients With Sepsis: A Meta-Analysis of Randomized Controlled Trials

Use of dexmedetomidine in patients with sepsis: a systematic review and meta-analysis of randomized-controlled trials

A comprehensive overview of clinical research on dexmedetomidine in the past 2 decades: A bibliometric analysis

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