The Effect of Dexmedetomidine on Inflammatory Factors and Clinical Outcomes in Patients With Septic Shock: A Randomized Clinical Trial

• Published in: Clinical therapeutics Vol. 47; no. 1; pp. e9 - e17
• Main Authors: Mokhlesian, Mahdi, Heydari, Fatemeh, Boskabadi, Seyyed Javad, Baradari, Afshin Gholipour, Ajami, Abolghasem, Alizadeh-Navaei, Reza
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2025; Elsevier Limited
• Subjects: Aged; Analgesics; Anesthesia; Biomarkers; Biomarkers - blood; Blood pressure; Chronic obstructive pulmonary disease; Clinical outcomes; Clinical trials; Cytokines; Delirium; Dexmedetomidine; Dexmedetomidine - administration & dosage; Dexmedetomidine - pharmacology; Dexmedetomidine - therapeutic use; Female; Guardians; Heart rate; Humans; Hypnotics and Sedatives - therapeutic use; IL-6; Inflammation; Inflammation Mediators - blood; Inflammatory cytokines; Interleukin 1; Interleukin 6; Interleukin-6 - blood; Internal Medicine; Intervention; Male; Midazolam; Midazolam - administration & dosage; Midazolam - therapeutic use; Middle Aged; Morphine; Morphine - administration & dosage; Morphine - therapeutic use; Mortality; Norepinephrine; Norepinephrine - administration & dosage; Norepinephrine - therapeutic use; Patients; Sepsis; Septic shock; Serum levels; Shock, Septic - blood; Shock, Septic - drug therapy; Shock, Septic - physiopathology; Software; TNF-α; Treatment Outcome; Tumor Necrosis Factor-alpha - blood; Tumor necrosis factor-α; Vital signs; Septic shock; Inflammatory cytokines; TNF-α; IL-6; Dexmedetomidine
• ISSN: 0149-2918; 1879-114X; 1879-114X
• DOI: 10.1016/j.clinthera.2024.11.004

•Dexmedetomidine is an α2-adrenoceptor agonist with sedative and anesthetic effects.•There are limited human studies on the effects of dexmedetomidine in septic shock.•In this clinical trial, we investigated the effect of dexmedetomidine on inflammatory factors, SOFA score, vital signs, and norepinephrine dose in septic shock patients.•Dexmedetomidine can regulate the inflammatory factors in patients with septic shock. Dexmedetomidine is a sedative-analgesic that is widely used in sepsis. However, its effect on septic shock remains unclear. This study aimed to investigate dexmedetomidine's effect on inflammatory biomarkers in septic shock. The present study was a randomized controlled clinical trial. Patients with inclusion criteria were randomly allocated into either the dexmedetomidine (n = 24) or morphine + midazolam group (n = 24). The primary outcome was changes in inflammatory factors, including IL-1, IL-6, TNF-α, ESR, and CRP. The serum levels of inflammatory factors were measured at baseline and the end of the intervention. Secondary outcomes included the change in norepinephrine dose, vital signs, and SOFA scores. Of the 48 subjects, 52.08% were male. After intervention, IL-1, IL-6, and TNF-α levels significantly differed between the 2 groups (p = 0.011 and p < 0.001 and p < 0.001, respectively). Heart rate and systolic blood pressure decreased over time, but the two groups had no significant difference (p-value > 0.05). In addition, there was no significant difference in norepinephrine dose and SOFA score between the 2 groups (p-value > 0.05). Sedation with dexmedetomidine can attenuate the inflammatory factors in septic shock. Also, dexmedetomidine did not worsen the hemodynamic parameters in septic shock patients.