Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis

Abstract

Sedatives are commonly used for mechanically ventilated patients in intensive care units (ICU). However, a variety of sedatives are available and their efficacy and safety have been compared in numerous trials with inconsistent results. To resolve uncertainties regarding usefulness of these sedatives, we performed a systematic review and network meta-analysis. Randomized controlled trials comparing sedatives in mechanically ventilated ICU patients were included. Graph-theoretical methods were employed for network meta-analysis. A total of 51 citations comprising 52 RCTs were included in our analysis. Dexmedetomidine showed shorter MV duration than lorazepam (mean difference (MD): 68.7; 95% CI: 18.2–119.3 hours), midazolam (MD: 10.2; 95% CI: 7.7–12.7 hours) and propofol (MD: 3.4; 95% CI: 0.9–5.9 hours). Compared with dexmedetomidine, midazolam was associated with significantly increased risk of delirium (OR: 2.47; 95% CI: 1.17–5.19). Our study shows that dexmedetomidine has potential benefits in reducing duration of MV and lowering the risk of delirium.

<p>Cost-Minimization Analysis of Dexmedetomidine Compared to Other Sedatives for Short-Term Sedation During Mechanical Ventilation in the United States</p>

“…2,3 Medications for sedation are routinely administered to critically ill patients treated in the ICU for a number of reasons, including to improve synchrony with or tolerance of MV. [6][7][8][9] The 2018 clinical practice guidelines from the Society of Critical Care Medicine (SCCM) recommend that light sedation be used in critically ill, mechanically ventilated adults. 7 Guidelines also generally recommend the use of nonbenzodiazepine sedatives (eg, propofol or dexmedetomidine) vs the use of benzodiazepine sedatives (eg, midazolam or lorazepam) in critically ill, mechanically ventilated patients because of the potential for improved short-term outcomes such as ICU length of stay (LOS), duration of MV, and delirium.…”

“…9,[13][14][15][16][17][18][19][20][21][22][23] These studies suggest that dexmedetomidine is associated with shorter ICU stays and decreased MV time, potentially contributing to decreased costs and improved patient satisfaction. 9,[13][14][15][16]18,[20][21][22]24,25 A larger clinical trial conducted in the US comparing dexmedetomidine to both propofol and midazolam also reported a reduction in intubation time and overall ICU/hospital LOS when dexmedetomidine was used. 18 To better understand the potential cost implication of these reported outcomes, we conducted a costminimization analysis from the hospital perspective of the impact of sedative choice for patients requiring MV for short-term sedation.…”

Effect of sedatives on in-hospital and long-term mortality of critically ill patients requiring extended mechanical ventilation for more than 48 hours

“…comparing sedatives in MV patients associated dexmedetomidine with a shorter MV duration than benzodiazepines and propofol, and shorter hospital LOS than propofol. The meta-analysis also showed that midazolam was associated with a significantly higher risk of delirium than dexmedetomidine [22].…”

The Effect of Dexmedetomidine Infusion on Oxygen Consumption and Energy Expenditure in Critically Ill Patients

“…Geniş bir farmakolojik özellik spektrumuna sahip, güçlü ve ileri derecede selektif alfa-2 adrenoreseptör agonist olan deksmedetomidin solunum depresyonuna yol açmaksızın sedasyon ve analjezi sağlaması ile yoğun bakımlarda kabul gören bir ajandır (10,15). Çalışmamızda deksmedetomidin kullanımı öncesi, infüzyonu sırasında ve kesildikten sonraki hemodinamik değişiklikler ve ET incelenmiş ve deksmedetomidin infüzyonunun olumlu hemodinamik etkiler yanında ET'yi azalttığı saptanmıştır.…”