Jean-Michel Constantin1, Aurelien Momon2, Jean Mantz3, Jean-François Payen4, Bernard De Jonghe5, Sebastien Perbet2, Sophie Cayot2, Gerald Chanques6, Bruno Perreira7. 1. Perioperative Department, University Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France. Electronic address: jmconstantin@chu-clermontferrand.fr. 2. Perioperative Department, University Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France. 3. Department of Anaesthesiology and Critical Care Medicine, Hôpital Européen Georges-Pompidou, Université Paris-Descartes Sorbonne Paris Cité, 75908 Paris, France. 4. Department of Anaesthesia and Critical Care, Michallon Hospital, boulevard de la Chantourne, 38000 Grenoble, France; Joseph-Fourier University, Grenoble Institute of Neurosciences, chemin Fortuné-Ferrini, 38042 Grenoble, France. 5. Réanimation Médico-Chirurgicale, Centre Hospitalier de Poissy-St-Germain, 78300 Poissy, France. 6. Intensive Care and Anaesthesiology Department, University of Montpellier Saint-Eloi Hospital, 34000 Montpellier, France. 7. Biostatistics Unit, Department of Clinical Research and Innovation, University Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France.
Abstract
INTRODUCTION: Dexmedetomidine may help physicians target a low level of sedation. Unfortunately, the impact of dexmedetomidine on major endpoints remains unclear in intensive care unit (ICU). MATERIAL AND METHODS: To evaluate the association between dexmedetomidine use with efficacy and safety outcomes, two reviewers independently identified randomized controlled trials comparing dexmedetomidine with other sedative agents in non-post-cardiac surgery critically ill patients in the PubMed and Cochrane databases. Random effects models were considered if heterogeneity was detected using the DerSimonian and Laird estimation method. Statistical heterogeneity between results was assessed by examining forest plots, confidence intervals (CI) and by using the I(2) statistic. The risk of bias was assessed using the risk of bias tool. RESULTS: This meta-analysis included 1994 patients from 16 randomized controlled trials. Comparators were lorazepam, midazolam and propofol. Dexmedetomidine was associated with a reduction in ICU length of stays (WMD=-0.304; 95% CI [-0.477, -0.132]; P=0.001), mechanical ventilation duration (WMD=-0.313, 95% CI [-0.523, -0.104]; P=0.003) and delirium incidence (RR=0.812, 95% CI [0.680, 0.968]; P=0.020). Dexmedetomidine is also associated with an increase in the incidence of bradycardia (RR=1.947, 95% CI [1.387, 2.733]; P=0.001) and hypotension (RR=1.264; 95% CI [1.013, 1.576]; P=0.038). CONCLUSIONS AND RELEVANCE: In this first meta-analysis including only randomized controlled trials related to ICU patients, dexmedetomidine was associated with a 48h reduction in ICU length of stay, mechanical ventilation duration and delirium occurrence despite a significant heterogeneity among studies. Dexmedetomidine was also associated with an increase in bradycardia and hypotension.
INTRODUCTION:Dexmedetomidine may help physicians target a low level of sedation. Unfortunately, the impact of dexmedetomidine on major endpoints remains unclear in intensive care unit (ICU). MATERIAL AND METHODS: To evaluate the association between dexmedetomidine use with efficacy and safety outcomes, two reviewers independently identified randomized controlled trials comparing dexmedetomidine with other sedative agents in non-post-cardiac surgery critically ill patients in the PubMed and Cochrane databases. Random effects models were considered if heterogeneity was detected using the DerSimonian and Laird estimation method. Statistical heterogeneity between results was assessed by examining forest plots, confidence intervals (CI) and by using the I(2) statistic. The risk of bias was assessed using the risk of bias tool. RESULTS: This meta-analysis included 1994 patients from 16 randomized controlled trials. Comparators were lorazepam, midazolam and propofol. Dexmedetomidine was associated with a reduction in ICU length of stays (WMD=-0.304; 95% CI [-0.477, -0.132]; P=0.001), mechanical ventilation duration (WMD=-0.313, 95% CI [-0.523, -0.104]; P=0.003) and delirium incidence (RR=0.812, 95% CI [0.680, 0.968]; P=0.020). Dexmedetomidine is also associated with an increase in the incidence of bradycardia (RR=1.947, 95% CI [1.387, 2.733]; P=0.001) and hypotension (RR=1.264; 95% CI [1.013, 1.576]; P=0.038). CONCLUSIONS AND RELEVANCE: In this first meta-analysis including only randomized controlled trials related to ICU patients, dexmedetomidine was associated with a 48h reduction in ICU length of stay, mechanical ventilation duration and delirium occurrence despite a significant heterogeneity among studies. Dexmedetomidine was also associated with an increase in bradycardia and hypotension.
Authors: Edmund H Jooste; Gregory B Hammer; Christian R Reyes; Vaibhav Katkade; Peter Szmuk Journal: Front Pharmacol Date: 2017-08-11 Impact factor: 5.810
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Authors: Simon Poignant; Bernard Vigué; Patricia Balram; Mathieu Biais; Romain Carillon; Vincent Cottenceau; Claire Dahyot-Fizelier; Vincent Degos; Thomas Geeraerts; Patrick Jeanjean; Emmanuel Vega; Sigismond Lasocki; Fabien Espitalier; Marc Laffon Journal: Neurocrit Care Date: 2021-07-30 Impact factor: 3.210