Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients: a meta-analysis
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To assess the effects of using dexmedetomidine as a sedative and analgesic agent on length of intensive care unit (ICU) stay, duration of mechanical ventilation, risk of bradycardia, and hypotension in critically ill adult patients.
Two researchers searched MEDLINE, EMBASE, and the Cochrane controlled trial register independently for randomized controlled trials comparing dexmedetomidine with a placebo or an alternative sedative agent, without any language restrictions.
A total of 2,419 critically ill patients from 24 trials were subject to meta-analysis. Dexmedetomidine was associated with a significant reduction in length of ICU stay [weighted mean difference −0.48 days, 95% confidence interval (CI) −0.18 to −0.78 days, P = 0.002], but not duration of mechanical ventilation, when compared with an alternative sedative agent. There was, however, significant heterogeneity in these two outcomes between the pooled studies. Dexmedetomidine was associated with increased risk of bradycardia requiring interventions in studies that used both a loading dose and maintenance doses >0.7 μg kg−1 h−1 [relative risk (RR) 7.30, 95% CI 1.73–30.81, P = 0.007]. Risks of hypotension requiring interventions (RR 1.43, 95% CI 0.78–2.6, P = 0.25), delirium (RR 0.79, 95% CI 0.56–1.11, P = 0.18), self-extubation, myocardial infarction, hyperglycemia, atrial fibrillation, and mortality were not significantly different between dexmedetomidine and traditional sedative and analgesic agents.
Significant heterogeneity existed between the pooled studies. The limited evidence suggested that dexmedetomidine might reduce length of ICU stay in some critically ill patients, but the risk of bradycardia was significantly higher when both a loading dose and high maintenance doses (>0.7 μg kg−1 h−1) were used.
KeywordsBradycardia Hypotension Intensive care unit Outcomes Sedation
The study was solely funded by Department of Intensive Care Medicine, Royal Perth Hospital. The funding source had no role in the collection, analysis, and interpretation of the data or in the decision to submit the manuscript for publication.
Conflict of interest statement
All authors have no financial interest to declare in relation to the subject matter of this manuscript.
- 8.Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, Vedio A, Singer M, Feneck R, Treacher D, Willatts SM, Grounds RM (1999) Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia 54:1136–1142CrossRefPubMedGoogle Scholar
- 9.Huupponen E, Maksimow A, Lapinlampi P, Särkelä M, Saastamoinen A, Snapir A, Scheinin H, Scheinin M, Meriläinen P, Himanen SL, Jääskeläinen S (2008) Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep. Acta Anaesthesiol Scand 52:289–294CrossRefPubMedGoogle Scholar
- 14.Wahlander S, Frumento RJ, Wagener G, Saldana-Ferretti B, Joshi RR, Playford HR, Sladen RN (2005) A prospective, double-blind, randomized, placebo-controlled study of dexmedetomidine as an adjunct to epidural analgesia after thoracic surgery. J Cardiothorac Vasc Anesth 19:630–635CrossRefPubMedGoogle Scholar
- 17.Shehabi Y, Grant P, Wolfenden H, Hammond N, Bass F, Campbell M, Chen J (2009) Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology 111:1075–1084CrossRefPubMedGoogle Scholar
- 18.Triltsch AE, Welte M, von Homeyer P, Grosse J, Genähr A, Moshirzadeh M, Sidiropoulos A, Konertz W, Kox WJ, Spies CD (2002) Bispectral index-guided sedation with dexmedetomidine in intensive care: a prospective, randomized, double blind, placebo-controlled phase II study. Crit Care Med 30:1007–1014CrossRefPubMedGoogle Scholar
- 24.Elbaradie S, El Mahalawy FH, Solyman AH (2004) Dexmedetomidine vs. propofol for short-term sedation of postoperative mechanically ventilated patients. J Egypt Natl Cancer Inst 16:153–158Google Scholar
- 25.Ruokonen E, Parviainen I, Jakob SM, Nunes S, Kaukonen M, Shepherd ST, Sarapohja T, Bratty JR, Takala J, “Dexmedetomidine for Continuous Sedation” Investigators (2009) Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation. Intensive Care Med 35:282–290CrossRefPubMedGoogle Scholar
- 33.Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG, SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group (2009) Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 301:489–499CrossRefPubMedGoogle Scholar
- 34.Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, Shintani AK, Thompson JL, Jackson JC, Deppen SA, Stiles RA, Dittus RS, Bernard GR, Ely EW (2007) Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 298:2644–2653CrossRefPubMedGoogle Scholar
- 35.Ozkan N, Sahin N, Karakaya Kabukcu H, Celikbilek G, Aydogdu Titiz T (2007) Comparison of the effects of dexmedetomidine with midasolam on haemodynamics and oxygen profile in patients undergoing coronary artery bypass grafting. Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi 13:161–168Google Scholar
- 39.Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomised controlled trial. Lancet 371:126–134CrossRefPubMedGoogle Scholar
- 40.Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874–1882CrossRefPubMedGoogle Scholar