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.

中文翻译：

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右美托咪定在脓毒症患者中的应用：随机对照试验的系统评价和荟萃分析

背景

右美托咪定广泛用于脓毒症患者。然而，它对脓毒症患者的影响仍然存在争议。本研究的目的是总结所有检查右美托咪定在脓毒症患者中使用的随机对照试验 (RCT)。

方法

该系统评价和荟萃分析包括比较右美托咪定与其他镇静剂在成人脓毒症患者中的随机对照试验。我们生成了汇总相对风险 (RR) 和标准化平均差，并进行了试验序贯分析和累积荟萃分析。主要结局是死亡率，次要结局是重症监护病房住院时间、机械通气持续时间、无通气天数、总不良事件发生率、谵妄发生率、白细胞介素 6 水平、肿瘤坏死α因子和丙氨酸氨基转移酶。

结果

我们纳入了 19 项随机对照试验，招募了 1929 名患者。与其他镇静剂相比，右美托咪定降低全因死亡率（RR 0.83；95% 置信区间 [CI] [0.69, 0.99]）和炎症反应（24 小时白细胞介素 6 和肿瘤坏死因子 α 水平：标准化平均差（SMD ) − 2.15；95% CI [− 3.25, − 1.05] 和 SMD − 1.07, 95% CI [− 1.92, − 0.22])。试验序列分析表明它没有达到所需的信息量。右美托咪定与其他镇静剂的总体风险不良事件相似（RR 1.27, 95% CI [0.69, 2.36]），但右美托咪定增加了心律失常的风险（RR 1.43, 95% CI [0.59, 3.51]）。重症监护病房住院时间 (SMD - 0.22; 95% CI [- 0.85, - 0.41])，机械通气时间 (SMD 0.12; 95% CI [- 1.10, 1.35])，谵妄发生率 (RR 0. 98; 95% CI [0.72, 1.33]），24 小时谷丙转氨酶和肌酐水平没有显着降低。

结论

与苯二氮卓类药物相比，脓毒症患者的右美托咪定可显着降低死亡率，但与丙泊酚相比则不然。此外，与其他镇静剂相比，右美托咪定可显着降低脓毒症患者的炎症反应。右美托咪定可能导致心律失常发生率增加，但其安全性特征并未显示出总不良事件发生率的显着差异。需要未来的随机对照试验来确定最能从右美托咪定及其最佳给药方案中受益的脓毒症患者群体。