Dexmedetomidine Versus Propofol for Patients With Sepsis Requiring Mechanical Ventilation: A Systematic Review and Meta-Analysis

Abstract

Purpose: This meta-analysis was performed to access the influence of dexmedetomidine versus propofol for adult patients with sepsis undergoing mechanical ventilation.Materials and Methods: NCBI PUBMED, Cochrane Library, Embase, China National Knowledge Internet (CNKI), and China Biological Medicine (CBM) were searched. Revman 5.3 and Stata software (version 12.0, Stata Corp LP, College Station, TX, United States) were used for meta-analysis.Results: Fifteen studies were included, and the data from the included studies were incorporated into the meta-analysis. Also, the result shows that compared with propofol, dexmedetomidine does not reduce 28-day mortality [risk ratios (RR) =0.97, 95% confidence interval (CI) =0.83–1.13, p = 0.70]. However, our analysis found that dexmedetomidine could reduce intensive care unit (ICU) stays {standard mean difference (SMD): −0.15; 95% CI: [−0.30–(−0.01)], p = 0.03}, duration of mechanical ventilation {SMD: −0.22; 95% CI: [−0.44–(−0.01)], p = 0.043}, sequential organ failure assessment (SOFA) {SMD: −0.41; 95% CI: [−0.73–(−0.09)], p = 0.013}, levels of interleukin-6 (IL-6) at 24 h (SMD: −2.53; 95% CI: −5.30-0.24, p = 0.074), and levels of CK-MB at 72 h {SMD: −0.45; 95% CI: [−0.83–(−0.08)], p = 0.017}.Conclusions: This meta-analysis (MA) suggests that in terms of 28-day mortality, sepsis patients with the treatment of dexmedetomidine did not differ from those who received propofol. In addition, more high-quality trials are needed to confirm these findings.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/#recordDetails, identifier CRD42021249780.

Comparison of Dexmedetomidine Versus Propofol in Mechanically Ventilated Patients With Sepsis: A Meta-Analysis of Randomized Controlled Trials

“…Our outcomes were different from that of several similar previous meta-analyses ( Zhang et al, 2019 ; Chen et al, 2020 ; Huang et al, 2021 ; Wang et al, 2021 ; Abdelazeem et al, 2022 ; Liu et al, 2022 ). Chen et al ( Chen et al, 2020 ) reported that DEX increased the number of ventilator-free days and reduced 28-day mortality for sedation among mechanically ventilated adult sepsis or septic shock patients, and Zhang et al ( Zhang et al, 2019 ) concluded that dexmedetomidine could dramatically reduce 28-day mortality.…”

“…Furthermore, their interventions of the control group were broad, including sedatives such as midazolam and lorazepam. Although four meta-analyses ( Huang et al, 2021 ; Wang et al, 2021 ; Abdelazeem et al, 2022 ; Liu et al, 2022 ) draw the similar primary outcome as we were in the previous year, we believed that our present study was more persuasive than those because of the larger sample size and the more specific control group. As the rigorous eligibility criteria we designed, our present meta-analysis, including 1,212 patients and setting propofol intervention principally for the control group, rendered the results more convincing.…”

“…Although these meta-analyses draw the similar primary outcome, several limitations existed indeed. Huang et al ( Huang et al, 2021 ) involved fifteen trials, but the majority of their trials were published in Chinese and only four studies were published in English. It was believed that the language would limit the extrapolation of results and it was hard to guarantee the quality of research.…”

Use of dexmedetomidine in patients with sepsis: a systematic review and meta-analysis of randomized-controlled trials

“…Several systematic reviews and meta-analyses on this research topic have been previously conducted [ 11 ] [ 12 ] [ 13 ] [ 49 ] [ 14 ]. Among previous meta-analyses, Huang et al was the most comprehensive study [ 13 ], and it included 15 RCTs with 1,871 patients in the analysis.…”

“…Recent four meta-analyses have shown controversial results, where two of these studies [ 11 ] [ 12 ] suggested a positive effect of dexmedetomidine on mortality in sepsis patients, while two other studies [ 13 ] [ 14 ] did not find a significant difference in mortality between dexmedetomidine and the other sedative agents. However, these conclusions are limited by the number of included studies, and the effects of dexmedetomidine on the incidence of delirium, adverse events, and the length of intensive care unit (ICU) stay remains controversial.…”