Aiman Awaiz, MD
Resident Physician
Mountainview Hospital, United States
Disclosure information not submitted.
Elizabeth Benge, MD
Resident Physician
Mountainview Hospital, United States
Disclosure information not submitted.
Maha Hassan, MD
Clinical Researcher
St. Michael's Hospital, University of Toronto, United States
Disclosure information not submitted.
Jon Halling, MD
Attending Physician
Mountainview Hospital, United States
Disclosure information not submitted.
Yi McWhorter, DO
Attending Physician
Mountainview Hospital, United States
Disclosure information not submitted.
Title: Dexmedetomidine vs. Propofol in Reducing Delirium in ICU Patients- A Review & Meta-analysis
Introduction: The primary goal of sedation in the intensive care unit (ICU) is to keep patients calm and without pain. Sedation is mostly combined with analgesia to facilitate assisted ventilation, and counter physiologic responses to stress such as tachycardia and hypertension. The goal of our study is to assess and compare the clinical performance of dexmedetomidine and propofol in elucidating the relative superiority of one pharmacologic sedation agent over the other.
Methods: A systematic review and meta-analysis was conducted of all randomized controlled trials available to date, investigating the clinical benefits of dexmedetomidine versus propofol for sedation in adult intensive care patients. The primary outcomes of our study were the incidence of delirium, duration of mechanical ventilation, length of ICU stay, sedation scores and hemodynamic variability. Secondary outcomes included infusion times, mortality.
Results: Eighteen randomized controlled trials with a total of 2094 patients were included in our study . Sufficient data were available for the analysis of eleven clinically relevant outcomes. The following outcomes demonstrated statistical significance, favoring dexmedetomidine: heart rate (95% CI -14.23, -3.34, p = 0.002), delirium (95% CI 0.16, 0.63, p = 0.001), hospital stay (95% CI -4.05, -0.18, p = 0.03), ICU stay (95% CI -27.18, -1.50, p = 0.03), extubating time (95% CI -1.23, -0.57, p < 0.00001), infusion time (95% CI -0.21, -0.01, p = 0.03). Dexmedetomidine and propofol performed equivocally in the remaining outcomes: BP-low MAP (95% CI -4.13, 4.95, p = 0.86), Death/Mortality (95% CI 0.61, 1,26, p = 0.47), BP-MAP (95% CI -9.34, 3.77, p = 0.40), APACHE score (95% CI -0.79, 1.86, p = 0.43), Operative time (95% CI -0.25, -0.31, p = 0.83).
Conclusion: Based on the results of our meta-analysis, we conclude that dexmedetomidine induces lower rates of peri-operative delirium, elicits clinically optimal (lower) heart rates, produces truncated extubation and infusion times, and is associated with shorter hospital and ICU stays when compared to propofol. In other fields of comparison, these two agents performed similarly. Thus, our results suggest that dexmedetomidine should be preferred over propofol for the sedation of adult patients in the ICU.