Dexmedetomidine reduces the risk of delirium, agitation and confusion in critically Ill patients: A meta-analysis of randomized controlled trials

Laura Pasin, Giovanni Landoni, Pasquale Nardelli, Alessandro Belletti, Ambra Licia Di Prima, Daiana Taddeo, Francesca Isella, Alberto Zangrillo

Research output: Contribution to journalArticle

Abstract

Objectives Delirium frequently is observed in critically ill patients in the intensive care unit (ICU) and is associated strongly with a poor outcome. Dexmedetomidine seems to reduce time to extubation and ICU stay without detrimental effects on mortality. The objective of the authors' study was to evaluate the effect of this drug on delirium, agitation, and confusion in the ICU setting.

Design Meta-analysis of all the randomized clinical trials ever performed on dexmedetomidine versus any comparator in the ICU setting.

Setting Intensive care units.

Participants Critically ill patients.

Interventions None

Measurements and Main Results Pertinent studies were independently searched in BioMedCentral, PubMed, Embase, and the Cochrane Central Register of clinical trials. Primary endpoint was the rate of delirium, including the adverse events, agitation and confusion. The 13 included manuscripts (14 trials) randomized 3,029 patients. Overall analysis showed that the use of dexmedetomidine was associated with significant reductions in the incidence of delirium, agitation and confusion (298/1,565 [19%] in the dexmedetomidine group v 337/1,464 [23%] in the control group, RR = 0.68 [0.49 to 0.96], p = 0.03). Results were confirmed in subanalyses performed on patients undergoing noninvasive ventilation (1/53 [2%] in the dexmedetomidine group v 7/49 [14%] in the control group, RR=0.18 [0.03 to 1.01], p = 0.05), receiving midazolam as a comparator (268/1,164 [23%] in the dexmedetomidine group v 277/1,025 [27%] in the control group, RR = 0.68 [0.47 to 1.00], p = 0.05) and in general ICU setting patients (204/688 [30%] in the dexmedetomidine group v 204/560 [36%] in the control group, RR = 0.68 [0.45 to 0.81], p<0.01).

Conclusions This meta-analysis of randomized controlled studies suggests that dexmedetomidine could help to reduce delirium in critically ill patients.

Original languageEnglish
Pages (from-to)1459-1466
Number of pages8
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume28
Issue number6
DOIs
Publication statusPublished - Dec 1 2014

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Keywords

  • agitation
  • confusion
  • delirium
  • dexmedetomidine
  • intensive care unit

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine
  • Medicine(all)

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