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Review
. 2022 Aug 27;12(1):81.
doi: 10.1186/s13613-022-01052-2.

Use of dexmedetomidine in patients with sepsis: a systematic review and meta-analysis of randomized-controlled trials

Ting Zhang #  1   2 , Qimin Mei #  1 , Shabai Dai  3 , Yecheng Liu  4 , Huadong Zhu  5
Affiliations
Review

Use of dexmedetomidine in patients with sepsis: a systematic review and meta-analysis of randomized-controlled trials

Ting Zhang et al. Ann Intensive Care. .

Abstract

Background: Dexmedetomidine is widely used in patients with sepsis. However, its effect on septic patients remains controversial. The objective of this study was to summarize all randomized controlled trials (RCTs) examining dexmedetomidine use in sepsis patients.

Methods: This systematic review and meta-analysis included RCTs comparing dexmedetomidine with other sedatives in adult sepsis patients. We generated pooled relative risks (RRs) and standardized mean differences and performed trial sequential analysis and a cumulative meta-analysis. The primary outcome was mortality, and the secondary outcomes were the length of the intensive care unit stay, duration of mechanical ventilation, number of ventilation-free days, incidence of total adverse event, incidence of delirium, and levels of interleukin 6, tumor necrosis factor alpha, and alanine aminotransferase.

Results: We included 19 RCTs that enrolled 1929 patients. Compared with other sedatives, dexmedetomidine decreased the all-cause mortality (RR 0.83; 95% confidence interval [CI] [0.69, 0.99]) and inflammatory response (interleukin 6 and tumor necrosis factor alpha levels at 24 h: standardized mean difference (SMD) - 2.15; 95% CI [- 3.25, - 1.05] and SMD - 1.07, 95% CI [- 1.92, - 0.22], respectively). Trial sequential analysis showed that it is not up to required information size. The overall risk adverse events was similar between dexmedetomidine and the other sedatives (RR 1.27, 95% CI [0.69, 2.36]), but dexmedetomidine increased the risk of arrhythmias (RR 1.43, 95% CI [0.59, 3.51]). Length of intensive care unit stay (SMD - 0.22; 95% CI [- 0.85, - 0.41]), duration of mechanical ventilation (SMD 0.12; 95% CI [- 1.10, 1.35]), incidence of delirium (RR 0.98; 95% CI [0.72, 1.33]), and levels of alanine aminotransferase and creatinine at 24 h were not significantly reduced.

Conclusions: Dexmedetomidine in sepsis patients could significantly reduce mortality compared with benzodiazepines but not with propofol. In addition, dexmedetomidine can significantly decrease inflammatory response in patients with sepsis compared with other sedatives. Dexmedetomidine might lead to an increased incidence of arrhythmias, but its safety profile did not show significant differences in the incidence of total adverse events. Future RCTs are needed to determine the sepsis patient population that would benefit most from dexmedetomidine and its optimal dosing regimen.

Keywords: Dexmedetomidine; Inflammatory response; Intensive critical care; Meta-analysis; Mortality; Sedatives; Sepsis; Survival.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram for study inclusions
Fig. 2
Fig. 2
Risk of bias assessment
Fig. 3
Fig. 3
Effect of dexmedetomidine on mortality
Fig. 4
Fig. 4
Trial sequential analysis
Fig. 5
Fig. 5
Cumulative meta-analysis. Pooled risk ratios are updated each time a new study was published
See this image and copyright information in PMC

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