Abstract
Background: Although clinical studies have evaluated dexmedetomidine as a strategy to improve noninvasive ventilation (NIV) comfort and tolerance in patients with acute respiratory failure (ARF), their results have not been summarized. Research Question: Does dexmedetomidine, when compared with another sedative or placebo, reduce the risk of delirium, mortality, need for intubation and mechanical ventilation, or ICU length of stay (LOS) in adults with ARF initiated on NIV in the ICU? Study Design and Methods: We electronically searched MEDLINE, EMBASE, and the Cochrane Library from inception through July 31, 2020, for randomized clinical trials (RCTs). We calculated pooled relative risks (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes with the corresponding 95% CIs using a random-effect model. Results: Twelve RCTs were included in our final analysis (n = 738 patients). The use of dexmedetomidine, compared with other sedation strategies or placebo, reduced the risk of intubation (RR, 0.54; 95% CI, 0.41-0.71; moderate certainty), delirium (RR, 0.34; 95% CI, 0.22-0.54; moderate certainty), and ICU LOS (MD, –2.40 days; 95% CI, –3.51 to –1.29 days; low certainty). Use of dexmedetomidine was associated with an increased risk of bradycardia (RR, 2.80; 95% CI, 1.92-4.07; moderate certainty) and hypotension (RR, 1.98; 95% CI, 1.32-2.98; moderate certainty). Interpretation: Compared with any sedation strategy or placebo, dexmedetomidine reduced the risk of delirium and the need for mechanical ventilation while increasing the risk of bradycardia and hypotension. The results are limited by imprecision, and further large RCTs are needed. Trial Registry: PROSPERO; No.: 175086; URL: www.crd.york.ac.uk/prospero/
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Chest |
| Vol/bind | 159 |
| Udgave nummer | 6 |
| Sider (fra-til) | 2274-2288 |
| Antal sider | 15 |
| ISSN | 0012-3692 |
| DOI | |
| Status | Udgivet - 2021 |
Bibliografisk note
Funding Information:Author contributions: K. L. guarantees the content of the manuscript, including the data and analysis. K. L. J. P. J. W. D. and W. A. contributed to the study conception and design. Data collection was carried out by K. L. and J. P. Material preparation and analysis were performed by K. L. J. P. D. C. and M. H. M. The first draft of the manuscript was written by K. L. J. P. D. C. and W. A. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Financial/nonfinancial disclosures: None declared. Other contributions: The authors thank Karin Dearness, MLIS, for her continuous support and wisdom in all things related to search strategies. Additional information: The e-Figures and e-Tables can be found in the Supplemental Materials section of the online article.
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© 2021 American College of Chest Physicians