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Meta-Analysis
. 2023 Apr;67(4):382-411.
doi: 10.1111/aas.14208. Epub 2023 Feb 7.

Dexmedetomidine for the prevention of delirium in adults admitted to the intensive care unit or post-operative care unit: A systematic review of randomised clinical trials with meta-analysis and Trial Sequential Analysis

Mathias Maagaard  1 , Marija Barbateskovic  2 , Nina C Andersen-Ranberg  1 , Jonas R Kronborg  3 , Ya-Xin Chen  4 , Huan-Huan Xi  5 , Anders Perner  6 , Jørn Wetterslev  7
Affiliations
Meta-Analysis

Dexmedetomidine for the prevention of delirium in adults admitted to the intensive care unit or post-operative care unit: A systematic review of randomised clinical trials with meta-analysis and Trial Sequential Analysis

Mathias Maagaard et al. Acta Anaesthesiol Scand. 2023 Apr.

Abstract

Objectives: To assess any benefit or harm, we conducted a systematic review of randomised clinical trials (RCTs) allocating adults to dexmedetomidine versus placebo/no intervention for the prevention of delirium in intensive care or post-operative care units.

Data sources: We searched Medline, Embase, CENTRAL and other databases. The last search was 9 April 2022.

Data extraction: Literature screening, data extraction and risk of bias volume 2 assessments were performed independently and in duplicate. Primary outcomes were occurrences of serious adverse events (SAEs), delirium and all-cause mortality. We used meta-analysis, Trial Sequential Analysis, and GRADE (Grading Recommendations Assessment, Development and Evaluation).

Data synthesis: Eighty-one RCTs (15,745 patients) provided data for our primary outcomes. Results from trials at low risk of bias showed that dexmedetomidine may reduce the occurrence of the most frequently reported SAEs (relative risk [RR] 0.69; 95% CI 0.43-1.09), cumulated SAEs (RR 0.70; 95% CI 0.52-0.95) and the occurrence of delirium (RR 0.62; 95% CI 0.43-0.89). The certainty of evidence was very low for delirium. Mortality was very low in trials at low risk of bias (0.4% in the dexmedetomidine groups and 1.0% in the control groups) and meta-analysis did not provide conclusive evidence that dexmedetomidine may result in lower or higher all-cause mortality (RR 0.47; 95% CI 0.18-1.21). There was a lack of information from trial results at low risk of bias for all primary outcomes.

Conclusions: Trial results at low risk of bias showed that dexmedetomidine might reduce occurrences of SAEs and delirium, while no conclusive evidence was found for effects on all-cause mortality. The certainty of evidence ranged from very low for occurrence of delirium to low for the remaining outcomes.

Keywords: delirium; dexmedetomidine; intensive care unit; meta-analysis; post-operative; systematic review.

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References

REFERENCES

    1. Allen J, Alexander E. Prevention, recognition, and management of delirium in the intensive care unit. AACN Adv Crit Care. 2012;23(1):5-11. doi:10.1097/NCI.0b013e31822c3633; quiz 12-3.
    1. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients. Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703-2710.
    1. Jackson P, Khan A. Delirium in critically ill patients. Crit Care Clin. 2015;31(3):589-603. doi:10.1016/j.ccc.2015.03.011
    1. Kalabalik J, Brunetti L, El-Srougy R. Intensive care unit delirium: a review of the literature. J Pharm Pract. 2014;27(2):195-207. doi:10.1177/0897190013513804
    1. Pandharipande P, Cotton BA, Shintani A, et al. Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients. J Trauma. 2008;65(1):34-41. doi:10.1097/TA.0b013e31814b2c4d

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