Dexmedetomidine as a sedative agent in critically ill patients: a meta-analysis of randomized controlled trials

• Published in: PloS one Vol. 8; no. 12; p. e82913
• Main Authors: Pasin, Laura, Greco, Teresa, Feltracco, Paolo, Vittorio, Annalisa, Neto, Caetano Nigro, Cabrini, Luca, Landoni, Giovanni, Finco, Gabriele, Zangrillo, Alberto
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31.12.2013; Public Library of Science (PLoS)
• Subjects: Airway Extubation; Analgesics; Analysis; Anesthesia; Anesthesiology; Bias; Bradycardia - chemically induced; Clinical trials; Critical Care; Critical Illness - mortality; Dexmedetomidine - adverse effects; Dexmedetomidine - therapeutic use; Extubation; FDA approval; Health aspects; Heart surgery; Heterogeneity; Hospital patients; Humans; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - therapeutic use; Hypotension - chemically induced; Intensive care; Length of Stay; Medical research; Medicine; Meta-analysis; Mortality; Patients; Randomization; Randomized Controlled Trials as Topic; Risk management; Sepsis; Studies; Time Factors; Ventilation; Ventilators; Italy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0082913

The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time to extubation is still unclear. Pertinent studies were independently searched in BioMedCentral, PubMed, Embase, and the Cochrane Central Register of clinical trials (updated February first 2013). Randomized studies (dexmedetomidine versus any comparator) were included if including patients mechanically ventilated in an intensive care unit (ICU). Co-primary endpoints were the length of ICU stay (days) and time to extubation (hours). Secondary endpoint was mortality rate at the longest follow-up available. The 27 included manuscripts (28 trials) randomized 3,648 patients (1,870 to dexmedetomidine and 1,778 to control). Overall analysis showed that the use of dexmedetomidine was associated with a significant reduction in length of ICU stay (weighted mean difference (WMD) = -0.79 [-1.17 to -0.40] days, p for effect <0.001) and of time to extubation (WMD = -2.74 [-3.80 to -1.65] hours, p for effect <0.001). Mortality was not different between dexmedetomidine and controls (risk ratio = 1.00 [0.84 to 1.21], p for effect = 0.9). High heterogeneity between included studies was found. This meta-analysis of randomized controlled studies suggests that dexmedetomidine could help to reduce ICU stay and time to extubation, in critically ill patients even if high heterogeneity between studies might confound the interpretation of these results.