Daisuke Hasegawa, MD,
Resident
Mount Sinai Beth Israel
New York, NY
Disclosure information not submitted.
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Ryota Sato, MD
Staff Intensivist
The Queens Medical Center
Honolulu, Hawaii
Disclosure information not submitted.
Narut Prasitlumkum, MD
Fellow
University of California Riverside School of Medicine, United States
Disclosure information not submitted.
Kazuki Nishida, MD
Assistant Professor
Nagoya University Graduate School of Medicine, United States
Disclosure information not submitted.
Title: Effect of Dexmedetomidine on the Mortality in Sepsis: A Systematic Review and Meta-analysis
Introduction: Sedation is an essential component of critical care for patients undergoing mechanical ventilation. Previous two meta-analysis (Chen P et al. 2020 and Zhang WQ et al. 2019) reported that the use of dexmedetomidine, which is a selective alpha-2 adrenergic agonist, was associated with lower mortality. However, more recent large randomized-controlled trials (RCTs) in patients with sepsis reported that dexmedetomidine use was not associated with improved outcomes (Shehabi et al. 2019 and Hughes et al. 2021). Therefore, there is a need to summarize available evidence regarding the effect of dexmedetomidine use on mortality in septic patients. Thus, this systematic review and meta-analysis aimed to clarify whether treatment with dexmedetomidine could reduce the mortality on top of intensive care unit length of stay, and ventilator-free days in patients with sepsis.
Methods: Three major databases (Cochrane Central Register of Controlled Trials, MEDLINE, and Embase) were searched for RCTs, which compared the mortality of patients with sepsis who received dexmedetomidine and those who did not. Studies that (1) reported RCT results, (2) included patients with sepsis aged ≥ 18 years, and (3) included patients who received dexmedetomidine-centered sedation or conventional agents-centered sedation, including propofol or benzodiazepine, were selected for further analysis. Two investigators independently reviewed and verified each selected report and extracted the demographic and clinical characteristics of the patients and their outcomes. All analyses were performed using a random-effects model. The protocol of this systematic review and meta-analysis was registered at PROSPERO (CRD42021229933).
Results: Eight RCTs (N = 3,501 patients) were included in the analysis. Dexmedetomidine was not associated with significantly reduced mortality in patients with sepsis (risk ratio: 0.97; 95% confidence interval (CI): 0.87–1.10; P = 0.67, I2 = 13%), improved intensive care unit (ICU) length of stay [standardized mean difference (SMD): −0.23: 95% CI: −0.58–0.13; P = 0.21, I2 = 83%], or shorter ventilator-free days (SMD: 0.12: 95% CI: −0.12–0.37; P = 0.32, I2 = 52%).
Conclusions: Sedation with dexmedetomidine was not associated with significantly improved outcomes in patients with sepsis.