AUTHOR=Wang Caimu , Chen Qijiang , Wang Ping , Jin Weisheng , Zhong Chao , Ge Zisheng , Xu Kangmin 

TITLE=The Effect of Dexmedetomidine as a Sedative Agent for Mechanically Ventilated Patients With Sepsis: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.776882

DOI=10.3389/fmed.2021.776882

ISSN=2296-858X

ABSTRACT=<p><bold>Purpose:</bold> Dexmedetomidine has been shown to improve clinical outcomes in critically ill patients. However, its effect on septic patients remains controversial. Therefore, the purpose of this meta-analysis was to assess the effect of dexmedetomidine as a sedative agent for mechanically ventilated patients with sepsis.</p><p><bold>Methods:</bold> We searched PubMed, Embase, Scopus, and Cochrane Library from inception through May 2021 for randomized controlled trials that enrolled mechanically ventilated, adult septic patients comparing dexmedetomidine with other sedatives or placebo.</p><p><bold>Results:</bold> A total of nine studies involving 1,134 patients were included in our meta-analysis. The overall mortality (RR 0.97, 95%CI 0.82 to 1.13, <italic>P</italic> = <italic>0.6</italic>7, I<sup>2</sup> = 25%), length of intensive care unit stay (MD −1.12, 95%CI −2.89 to 0.64, <italic>P</italic> = <italic>0.2</italic>1, I<sup>2</sup> = 71%), incidence of delirium (RR 0.95, 95%CI 0.72 to 1.25, <italic>P</italic> = <italic>0.7</italic>0, I<sup>2</sup> = 0%), and delirium free days (MD 1.76, 95%CI –0.94 to 4.47, <italic>P</italic> = 0.20, I<sup>2</sup> = 80%) were not significantly different between dexmedetomidine and other sedative agents. Alternatively, the use of dexmedetomidine was associated with a significant reduction in the duration of mechanical ventilation (MD –0.53, 95%CI −0.85 to −0.21, <italic>P</italic> = <italic>0.0</italic>01, I<sup>2</sup> = 0%) and inflammatory response (TNF-α: MD −5.27, 95%CI −7.99 to −2.54, <italic>P</italic>&lt;<italic>0.0</italic>01, I<sup>2</sup> = 0%; IL-1β: MD −1.25, 95%CI −1.91 to –0.59, <italic>P</italic>&lt;<italic>0.0</italic>01, I<sup>2</sup> = 0%).</p><p><bold>Conclusions:</bold> For patients with sepsis, the use of dexmedetomidine as compared with other sedative agents does not affect all-cause mortality, length of intensive care unit stay, the incidence of delirium, and delirium-free days. But the dexmedetomidine was associated with the reduced duration of mechanical ventilation and inflammatory response.</p>