Dexmedetomidine reduces the risk of delirium, agitation and confusion in critically Ill patients: a meta-analysis of randomized controlled trials.
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.
['Pasin|Laura|L|', 'Landoni|Giovanni|G|', 'Nardelli|Pasquale|P|', 'Belletti|Alessandro|A|', 'Di Prima|Ambra Licia|AL|', 'Taddeo|Daiana|D|', 'Isella|Francesca|F|', 'Zangrillo|Alberto|A|']
D003221:Confusion D003422:Critical Care D016638:Critical Illness D003693:Delirium D020927:Dexmedetomidine D006801:Humans D006993:Hypnotics and Sedatives D011595:Psychomotor Agitation D016032:Randomized Controlled Trials as Topic
dexmedetomidine delirium agitation confusion intensive care unit