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The effect of dexmedetomidine on postoperative and intensive care unit delirium: A meta‐analysis of randomized controlled trials
Author(s) -
Jiang Fang,
Ye Xiaodong,
Cai Yin,
Xie Xiang,
Wang Lin,
Hua Lin-lin,
Xia Zhengyuan
Publication year - 2020
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.2020.34.s1.09241
Subject(s) - dexmedetomidine , medicine , delirium , intensive care unit , randomized controlled trial , bradycardia , cochrane library , anesthesia , odds ratio , subgroup analysis , incidence (geometry) , meta analysis , confidence interval , heart rate , sedation , intensive care medicine , blood pressure , physics , optics
Background The present meta‐analysis aimed to assess the efficacy of dexmedetomidine on the occurrence of delirium among critically ill patients in the postoperative and intensive care unit. Methods Pubmed, Embase, Cochrane Library (Central), Web of Science and Clinical Trails databases for randomized controlled trials (RCTs) were searched to compare the effect of dexmedetomidine administration in comparison with control group (normal saline or other anesthetic drugs) on the incidence of delirium in adult patients until April 4, 2019. The sensitivity and subgroup analyses were adopted. Statistical analysis was performed with RevMan software version 5.3 and Stata 12.0. The primary endpoint was the incidence of delirium. The secondary outcome included the occurrence of hypotension, hypertension, bradycardia and tachycardia. Results 20 RCTs were finally included in the analysis, with a total of 4,242 adult patients. The results of meta‐analysis showed that dexmedetomidine (odds ratio [OR]=0.47, 95% confidence interval [CI]: 0.35 to 0.64, p < 0.01) could significantly reduce the rate of delirium for the entire patients in the postoperative and intensive care unit when compared with control group. The subgroup analysis indicated that dexmedetomidine reduced the incidence of delirium between groups in cardiac surgery (OR=0.55, 95% CI: 0.30 to 0.98) and non‐cardiac surgery (OR=0.44, 95% CI: 0.31 to 0.64), normal saline (OR=0.47, 95% CI: 0.31 to 0.71) and anesthetic drugs (OR=0.50, 95% CI: 0.30 to 0.81), age ≥ 60 years old (OR=0.50, 95% CI: 0.36 to 0.68) and age < 60 years old (OR=0.34, 95% CI: 0.13 to 0.91), with loading dose (OR=0.38, 95% CI: 0.29 to 0.50) and without loading dose (OR=0.54, 95% CI: 0.44 to 0.67). However, there were no significant difference in delirium among mechanical ventilated patients (OR=0.30, 95% CI: 0.07 to 1.22) and in cardiac surgery patients with age ≥ 60 years old (OR=0.73, 95% CI: 0.44 to 1.22). Additionally, this analysis found that dexmedetomidine administration was associated with an increased incidence of hypertension (OR=0.54, 95% CI: 0.41 to 0.71) and bradycardia (OR=1.59, 95% CI: 1.25 to 2.03), while the incidence of hypotension (OR=0.90, 95% CI: 0.62 to 1.31) and tachycardia (OR=0.73, 95% CI: 0.37 to 1.45) did not differ significantly between dexmedetomidine treated and control groups.. Conclusion The present limited evidence suggests that dexmedetomidine can reduce the incidence of delirium in the postoperative and intensive care unit except in cardiac surgery patients with age ≥ 60. However, the pooled results should be interpreted with more caution due to significant statistical heterogeneity existed. Therefore, future high‐quality, large RCTs should further verify this findings among this population.