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Efficacy and safety of sedation with dexmedetomidine in critical care patients: A meta-analysis of randomized controlled trials

التفاصيل البيبلوغرافية
العنوان: Efficacy and safety of sedation with dexmedetomidine in critical care patients: A meta-analysis of randomized controlled trials
المؤلفون: Aurelien Momon, Sébastien Perbet, Sophie Cayot, Jean François Payen, Bernard De Jonghe, Bruno Perreira, Jean-Michel Constantin, Gerald Chanques, Jean Mantz
المساهمون: CHU Clermont-Ferrand, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Paris Descartes - Paris 5 (UPD5), Université Sorbonne Paris Cité (USPC), Service d'Anesthésie-Réanimation [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital Michallon, CHI Poissy-Saint-Germain, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)
المصدر: Anaesthesia Critical Care & Pain Medicine
Anaesthesia Critical Care & Pain Medicine, Elsevier Masson, 2016, 35 (1), pp.7-15. ⟨10.1016/j.accpm.2015.06.012⟩
بيانات النشر: HAL CCSD, 2016.
سنة النشر: 2016
مصطلحات موضوعية: Sedation, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, Randomized controlled trial, law, medicine, Humans, Hypnotics and Sedatives, Dexmedetomidine, ComputingMilieux_MISCELLANEOUS, Randomized Controlled Trials as Topic, business.industry, Delirium, 030208 emergency & critical care medicine, General Medicine, Intensive care unit, 3. Good health, Meta-analysis, Critical care, Anesthesiology and Pain Medicine, Anesthesia, Midazolam, medicine.symptom, business, Propofol, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
الوصف: Introduction Dexmedetomidine may help physicians target a low level of sedation. Unfortunately, the impact of dexmedetomidine on major endpoints remains unclear in intensive care unit (ICU). Material and methods To evaluate the association between dexmedetomidine use with efficacy and safety outcomes, two reviewers independently identified randomized controlled trials comparing dexmedetomidine with other sedative agents in non-post-cardiac surgery critically ill patients in the PubMed and Cochrane databases. Random effects models were considered if heterogeneity was detected using the DerSimonian and Laird estimation method. Statistical heterogeneity between results was assessed by examining forest plots, confidence intervals (CI) and by using the I 2 statistic. The risk of bias was assessed using the risk of bias tool. Results This meta-analysis included 1994 patients from 16 randomized controlled trials. Comparators were lorazepam, midazolam and propofol. Dexmedetomidine was associated with a reduction in ICU length of stays (WMD = −0.304; 95% CI [−0.477, −0.132]; P = 0.001), mechanical ventilation duration (WMD = −0.313, 95% CI [−0.523, −0.104]; P = 0.003) and delirium incidence (RR = 0.812, 95% CI [0.680, 0.968]; P = 0.020). Dexmedetomidine is also associated with an increase in the incidence of bradycardia (RR = 1.947, 95% CI [1.387, 2.733]; P = 0.001) and hypotension (RR = 1.264; 95% CI [1.013, 1.576]; P = 0.038). Conclusions and relevance In this first meta-analysis including only randomized controlled trials related to ICU patients, dexmedetomidine was associated with a 48 h reduction in ICU length of stay, mechanical ventilation duration and delirium occurrence despite a significant heterogeneity among studies. Dexmedetomidine was also associated with an increase in bradycardia and hypotension.
اللغة: English
تدمد: 2352-5568
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::56421c5bf18bb64825dcb39f2f912193
https://hal.umontpellier.fr/hal-01885256
حقوق: CLOSED
رقم الأكسشن: edsair.doi.dedup.....56421c5bf18bb64825dcb39f2f912193
قاعدة البيانات: OpenAIRE
الوصف
تدمد:23525568