Patients with sepsis frequently receive dexmedetomidine treatment. Some debate exists regarding how well it helps septic patients. Dexmedetomidine use in patients with sepsis has been the subject of numerous randomized controlled trials (RCTs), and this review aimed to compile the results of all of them. Researchers compared the effects of dexmedetomidine to those of other sedatives in adult patients with sepsis in a meta-analysis that comprised randomized controlled trials. Trial sequential analysis and a cumulative meta-analysis were conducted, and pooled relative risks (RRs) and standardized mean differences were calculated. The primary outcome was death, and the secondary outcomes included length of stay in the intensive care unit, ICU, length of mechanical ventilation, number of days without ventilation, incidence of total adverse events, incidence of delirium, and levels of interleukin 6, tumor necrosis factor alpha, and alanine aminotransferase. Investigators analyzed data from 19 randomized controlled trials (RCTs) that involved a total of 1,929 participants. Dexmedetomidine was associated with a lower risk of death from any cause (hazard ratio [HR] 0.83; 95% CI [0.69, 0.99]) and a reduced inflammatory response (levels of interleukin 6 and tumor necrosis factor alpha after 24 hours: standardized mean difference (SMD) – 2.15; 95% CI [-3.25, -1.05] and SMD -1.07, 95% CI [-1.92, -0.22]). The informational throughput of the trial sequential analysis was inadequate. Dexmedetomidine increased the incidence of arrhythmias (RR 1.43, 95% CI [0.59, 3.51]), but the total risk of adverse events was similar between dexmedetomidine and the other sedatives (RR 1.43, 95% CI [0.59, 3.51]). Neither the length of time time spent in the ICU (SMD -0.22; 95% CI [-0.85, 0.41]) nor the time spent on mechanical ventilation (SMD 0.12; 95% CI [-1.10, 1.35]), the occurrence of delirium (RR 0.98; 95% CI [0.72, 1.40]), nor the levels of alanine aminotransferase and creatinine at 24 hours were significantly decreased. Patients with sepsis who were given dexmedetomidine instead of benzodiazepines or propofol had considerably lower fatality rates. And unlike other sedatives, dexmedetomidine can considerably reduce the inflammatory response in individuals with sepsis. Dexmedetomidine has been linked to an uptick in arrhythmias, although its safety profile did not reveal any noteworthy variations in the frequency of adverse events overall. There is a need for more randomized controlled trials (RCTs) to identify the subset of patients with sepsis who would benefit most from dexmedetomidine and to establish an appropriate dose schedule for this drug.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-022-01052-2
