Meta-analysis comparing dexmedetomidine versus standard of care for sedation in patients with sepsis

Abdelazeem, Basel; Malik, Bilal Haider; Mohamed, Mohamed M G; Savarapu, Pramod; Isa, Sakiru; Kheiri, Babikir; Hassan, Mustafa

doi:10.1080/08998280.2021.1997063

Cited by 4 publications

(5 citation statements)

References 25 publications

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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: 51%

“…However, they only involved five RCTs and their comparison included lorazepam and midazolam. The meta-analysis implemented by Abdelazeem et al ( Abdelazeem et al, 2022 ) was also constrained by the same limitations, which might cause inaccurate results.…”

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: 51%

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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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“…Aso and colleagues report that dexmedetomidine is associated with reduced mortality in mechanically ventilated septic patients [ 21 ], which is similar to the mortality benefits of dexmedetomidine reported in septic patients by other authors [ 22 , 23 ]. By contrast, a meta-analysis by Abdelazeem et al, 2022, suggests that dexmedetomidine is not associated with reduced 28-day mortality, 90-day mortality, delirium-free days, ventilator-free days, changes in heart rate, or changes in mean arterial blood pressure when compared to the standard of care sedation in critically ill patients with sepsis [ 24 ]. A systematic review reports that dexmedetomidine may improve outcomes in patients with septic shock [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of a Dexmedetomidine Intravenous Infusion in Septic Dogs: Preliminary Study

Di Franco,

Boysen,

Vannozzi

et al. 2024

Animals

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The purpose of this study was to determine if a continuous rate infusion (CRI) of dexmedetomidine decreases vasopressor requirements in septic dogs undergoing surgery. Vital parameters, sequential organ failure assessment (SOFA) score, vasopressor requirement, and 28-day mortality were recorded. Dogs were randomly divided into two groups: a dexmedetomidine (DEX) (1 mcg/kg/h) group and a control group (NaCl), which received an equivalent CRI of NaCl. Dogs were premedicated with fentanyl 5 mcg/kg IV, induced with propofol, and maintained with sevoflurane and a variable rate fentanyl infusion. DEX or NaCl infusions were started 10 min prior to induction. Fluid-responsive hypotensive patients received repeated Ringer’s lactate boluses (2 mL/kg) until stable or they were no longer fluid-responsive. Patients that remained hypotensive following fluid boluses received norepinephrine at a starting dose of 0.05 mcg/kg/min, with increases of 0.05 mcg/kg/min. Rescue adrenaline boluses were administered (0.001 mg/kg) if normotension was not achieved within 30 min of starting norepinephrine. The NaCl group received a significantly higher dose of norepinephrine (0.8, 0.4–2 mcg/kg/min) than the DEX group (0.12, 0–0.86 mcg/kg/min). Mortality was statistically lower in the DEX group (1/10) vs. the NaCl group (5/6). Results of this study suggest that a 1 mcg/kg/h CRI of dexmedetomidine decreases the demand for intraoperative vasopressors and may improve survival in septic dogs.

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“…Dexmedetomidine (DEX) is an alpha-2-adrenoreceptor agonist [ 9 ] that has procedural sedative, analgesic, sedative, anxiolytic, and sympatholytic effects [ 10 , 11 ]. DEX downregulated the inflammatory reactions in rats [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Reno-protective effects of perioperative dexmedetomidine in kidney transplantation: a systematic review and meta-analysis of randomized controlled trials

Abuelazm

Ghanem²,

Johanis

et al. 2023

Int Urol Nephrol

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Background and objective There is currently no FDA-approved medical therapy for delayed graft function (DGF). Dexmedetomidine (DEX) has multiple reno-protective effects preventing ischemic reperfusion injury, DGF, and acute kidney injury. Therefore, we aimed to evaluate the reno-protective effects of perioperative DEX during renal transplantation. Methods A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) from WOS, SCOPUS, EMBASE, PubMed, and CENTRAL until June 8th, 2022. We used the risk ratio (RR) for dichotomous outcomes and the mean difference for continuous outcomes; both presented with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: CRD42022338898. Results We included four RCTs with 339 patients. Pooled risk ratio found no difference between DEX and placebo in reducing DGF (RR: 0.58 with 95% CI [0.34, 1.01], p = 0.05) and acute rejection (RR: 0.88 with 95% CI [0.52, 1.49], p = 0.63). However, DEX improved short-term creatinine on day 1 (MD: − 0.76 with 95% CI [− 1.23, − 0.3], p = 0.001) and day 2 (MD: − 0.28 with 95% CI [− 0.5, − 0.07], p = 0.01); and blood urea nitrogen on day 2 (MD: − 10.16 with 95% CI [− 17.21, − 3.10], p = 0.005) and day 3 (MD: − 6.72 with 95% CI [− 12.85, − 0.58], p = 0.03). Conclusion Although there is no difference between DEX and placebo regarding reducing DGF and acute rejection after kidney transplantation, there may be some evidence that it has reno-protective benefits because we found statistically significant improvement in the short-term serum creatinine and blood urea nitrogen levels. More trials are required to investigate the long-term reno-protective effects of DEX.

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Meta-analysis comparing dexmedetomidine versus standard of care for sedation in patients with sepsis

Cited by 4 publications

References 25 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

Impact of a Dexmedetomidine Intravenous Infusion in Septic Dogs: Preliminary Study

Reno-protective effects of perioperative dexmedetomidine in kidney transplantation: a systematic review and meta-analysis of randomized controlled trials

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