Background

Guidelines have recommended the use of dexmedetomidine or propofol for sedation after cardiac surgery, and propofol monotherapy for other patients. Further outcome data are required for these drugs.

Methods

This systematic review and meta-analysis was prospectively registered on PROSPERO. The primary outcome was ICU length of stay. Secondary outcomes included duration of mechanical ventilation, ICU delirium, all-cause mortality, and haemodynamic effects. Intensive care patients were analysed separately as cardiac surgical, medical/noncardiac surgical, those with sepsis, and patients in neurocritical care. Subgroup analyses based on age and dosage were conducted.

Results

Forty-one trials (N=3948) were included. Dexmedetomidine did not significantly affect ICU length of stay across any ICU patient subtype when compared with propofol, but it reduced the duration of mechanical ventilation (mean difference −0.67 h; 95% confidence interval: −1.31 to −0.03 h; P=0.041; low certainty) and the risk of ICU delirium (risk ratio 0.49; 95% confidence interval: 0.29–0.87; P=0.019; high certainty) across cardiac surgical patients. Dexmedetomidine was also associated with a greater risk of bradycardia across a variety of ICU patients. Subgroup analyses revealed that age might affect the incidence of haemodynamic side-effects and mortality among cardiac surgical and medical/other surgical patients.

Conclusion

Dexmedetomidine did not significantly impact ICU length of stay compared with propofol, but it significantly reduced the duration of mechanical ventilation and the risk of delirium in cardiac surgical patients. It also significantly increased the risk of bradycardia across ICU patient subsets.

中文翻译：

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右美托咪定与丙泊酚镇静在需要机械通气的危重成人患者中的疗效：随机对照试验的系统评价和荟萃分析

背景

指南建议心脏手术后使用右美托咪定或丙泊酚进行镇静，其他患者使用丙泊酚单药治疗。这些药物需要进一步的结果数据。

方法

这项系统评价和荟萃分析已在 PROSPERO 上前瞻性注册。主要结果是ICU住院时间。次要结局包括机械通气持续时间、ICU 谵妄、全因死亡率和血流动力学影响。重症监护患者被分别分析为心脏手术、内科/非心脏手术、脓毒症患者和神经重症监护患者。进行了基于年龄和剂量的亚组分析。

结果

包括41 项试验（N = 3948）。与丙泊酚相比，右美托咪定对任何 ICU 患者亚型的 ICU 住院时间没有显着影响，但它减少了机械通气的持续时间（平均差 -0.67 小时；95% 置信区间：-1.31 至 -0.03 小时；P = 0.041；低确定性）和心脏手术患者的 ICU 谵妄风险（风险比 0.49；95% 置信区间：0.29-0.87；P = 0.019；高确定性）。右美托咪定还与各种 ICU 患者的心动过缓风险增加有关。亚组分析显示，年龄可能会影响心脏手术和内科/其他手术患者的血流动力学副作用和死亡率的发生率。

结论

与丙泊酚相比，右美托咪定对 ICU 住院时间没有显着影响，但它显着降低了心脏手术患者的机械通气时间和谵妄风险。它还显着增加了 ICU 患者亚组心动过缓的风险。