Efficacy and safety of sedation with dexmedetomidine in critical care patients: A meta-analysis of randomized controlled trials

Jean Michel Constantin, Aurelien Momon, Jean Mantz, Jean François Payen, Bernard De Jonghe, Sebastien Perbet, Sophie Cayot, Gerald Chanques, Bruno Perreira

Research output: Contribution to journalArticlepeer-review

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 I2 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 48 h 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.

Original languageEnglish (US)
Pages (from-to)7-15
Number of pages9
JournalAnaesthesia Critical Care and Pain Medicine
Volume35
Issue number1
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

Keywords

  • Critical care
  • Delirium
  • Mechanical ventilation
  • Meta-analysis
  • Sedation

ASJC Scopus subject areas

  • Medicine(all)
  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

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