Does dexmedetomidine (vs. propofol) improve outcomes in adult after cardiac surgery?
Ayed Asir 1;Faizan Amin 2; Waleed Al-hazzani 3.
1; ICU department,Prince Mohammed bin Abdulaziz, Riyadh, Saudi Arbia
2;ICU department, McMaster University, Hamilton, Canada
3;ICU department, McMaster University, Hamilton, Canada
Introduction:
Current guidelines suggest that non-benzodiazepine sedatives are the preferred sedative agents in mechanically ventilated adults in the intensive care unit (ICU). Among those agents, it is uncertain whether dexmedetomidine is better than propofol for sedation in patients after cardiac surgery.
Objective:
We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the efficacy and safety of dexmedetomidine, compared to propofol, in adult patients after cardiac surgery.
Methods:
Two reviewers independently searched PubMed, Embase, OVID Medline, and the Cochrane Library up to January 31st, 2017. The same reviewers completed abstract screening, study selection, data abstraction, and risk of bias assessment using the Cochrane Collaboration’s tool for assessing risk of bias. We used the GRADE approach to assess the quality of evidence.
We included RCTs that enrolled adult post-cardiac surgery patients, comparing dexmedetomidine to propofol, and reported any of the following outcomes: delirium, duration of mechanical ventilation, ICU length of stay, opioid requirements, and mortality. We pooled the estimate of effects across studies using a random-effects model. The results were summarized as risk ratio (RR) for binary outcomes, and mean difference (MD) for continuous outcomes.
Results:
Out of 20 studies that met inclusion criteria, we included eight RCTs (1002 patients). Dexmedetomidine was associated with a lower risk of delirium (RR 0.29, 95% confidence interval [CI], 0.09-0.90; p=0.03), shorter duration of mechanical ventilation (hours; mean difference -0.93; 95% CI -1.24 to -0.63; p<0.00001), and lower need for opioids (mg of morphine-equivalents; mean difference -14.64, 95% CI -14.80 to -14.47; p<0.00001) compared to propofol. However, there was a higher incidence of bradycardia (RR 3.21, 95% CI 1.18-8.70; p=0.02), and hypotension (RR 1.30, 95% CI 1.05-1.62; p=0.02) with dexmedetomidine compared to propofol. There were no statistically significant differences in ICU length of stay, mortality, or incidence of atrial fibrillation between dexmedetomidine and propofol sedation regimens.
Conclusions:
Moderate quality evidence revealed that dexmedetomidine reduces postoperative delirium, shortens the duration of mechanical ventilation, and lowers opioid requirements after cardiac surgery, but may increase the incidence of bradycardia and hypotension compared with propofol.
Does dexmedetomidine (vs. propofol) improve outcomes in adult after cardiac surgery?
Ayed Asir 1;Faizan Amin 2; Waleed Al-hazzani 3.
1; ICU department,Prince Mohammed bin Abdulaziz, Riyadh, Saudi Arbia
2;ICU department, McMaster University, Hamilton, Canada
3;ICU department, McMaster University, Hamilton, Canada
Introduction:
Current guidelines suggest that non-benzodiazepine sedatives are the preferred sedative agents in mechanically ventilated adults in the intensive care unit (ICU). Among those agents, it is uncertain whether dexmedetomidine is better than propofol for sedation in patients after cardiac surgery.
Objective:
We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the efficacy and safety of dexmedetomidine, compared to propofol, in adult patients after cardiac surgery.
Methods:
Two reviewers independently searched PubMed, Embase, OVID Medline, and the Cochrane Library up to January 31st, 2017. The same reviewers completed abstract screening, study selection, data abstraction, and risk of bias assessment using the Cochrane Collaboration’s tool for assessing risk of bias. We used the GRADE approach to assess the quality of evidence.
We included RCTs that enrolled adult post-cardiac surgery patients, comparing dexmedetomidine to propofol, and reported any of the following outcomes: delirium, duration of mechanical ventilation, ICU length of stay, opioid requirements, and mortality. We pooled the estimate of effects across studies using a random-effects model. The results were summarized as risk ratio (RR) for binary outcomes, and mean difference (MD) for continuous outcomes.
Results:
Out of 20 studies that met inclusion criteria, we included eight RCTs (1002 patients). Dexmedetomidine was associated with a lower risk of delirium (RR 0.29, 95% confidence interval [CI], 0.09-0.90; p=0.03), shorter duration of mechanical ventilation (hours; mean difference -0.93; 95% CI -1.24 to -0.63; p<0.00001), and lower need for opioids (mg of morphine-equivalents; mean difference -14.64, 95% CI -14.80 to -14.47; p<0.00001) compared to propofol. However, there was a higher incidence of bradycardia (RR 3.21, 95% CI 1.18-8.70; p=0.02), and hypotension (RR 1.30, 95% CI 1.05-1.62; p=0.02) with dexmedetomidine compared to propofol. There were no statistically significant differences in ICU length of stay, mortality, or incidence of atrial fibrillation between dexmedetomidine and propofol sedation regimens.
Conclusions:
Moderate quality evidence revealed that dexmedetomidine reduces postoperative delirium, shortens the duration of mechanical ventilation, and lowers opioid requirements after cardiac surgery, but may increase the incidence of bradycardia and hypotension compared with propofol.