USE OF DEXMEDETOMIDINE IN CRITICALLY ILL PATIENTS RECEIVING NONINVASIVE VENTILATION: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

ABSTRACT

SESSION TITLE Advances in the Care of Mechanically-Ventilated Patients SESSION TYPE Original Investigations PRESENTED ON October 18-21, 2020 PURPOSE: Psychomotor agitation is one of the reasons for noninvasive ventilation (NIV) failure. Judicious sedation may mitigate agitation and improve patient-ventilator synchrony in patients receiving NIV. Dexmedetomidine is an alpha-2 adrenergic receptor agonist that exhibits sedative, anxiolytic, and analgesic properties. It can provide moderate sedation without compromising the respiratory drive. This study aims to summarize the existing evidence for dexmedetomidine use in patients receiving NIV. METHODS: Studies reviewed were selected based on relevance from a meta-analysis search conducted in Medline, EMBASE, Cochrane library, and Academic Search Elite to include all published randomized controlled trials through April 2020. Prospective studies were selected if they compared dexmedetomidine with other sedative agents or no sedation in patients who require NIV. Review Manager 5.3 (The Cochrane Collaboration) was used for meta-analysis and a random effect model was applied for statistical analysis. RESULTS: Six randomized controlled trials with a total of 505 patients matched the inclusion criteria. Forty-four patients (20.1%) in the dexmedetomidine group and 96 patients (39.8%) in the control group required escalation of therapy from NIV to intubation. Dexmedetomidine infusion significantly reduced the intubation rate (pooled odds ratio, 0.37;95% CI 0.24-0.58;p<0.0001) and ICU length of stay by 2.9 days (95% CI -4.38 to -1.44;p =0.0001). However, dexmedetomidine did not change the mortality rate (pooled odds ratio, 0.46;95% CI 0.1-1.78;p=0.26). Finally, patients who received dexmedetomidine infusion had a lower incidence of delirium (pooled odds ratio, 0.26;95% CI 0.15-0.45;p=0.003) but were more prone to bradycardia and hypotension. CONCLUSIONS: The present analysis suggests that dexmedetomidine use in patients receiving NIV could mitigate agitation and improve NIV tolerance. For patients who require sedation while receiving NIV, dexmedetomidine may be the preferred sedative agent as it does not carry deleterious effects on ventilatory function. Dexmedetomidine reduces the incidence of delirium but may affect hemodynamic profiles more than other agents. Given the heterogeneity and small sample size of included studies, future large-scale studies are needed to examine the role of dexmedetomidine use in patients receiving NIV. CLINICAL IMPLICATIONS Dexmedetomidine could be the preferred sedative agent for patients who have NIV intolerance due to agitation. Our analysis showed that clinical outcomes of dexmedetomidine use in NIV were encouraging, though further prospective studies are needed to confirm these results. In the era of COVID-19, dexmedetomidine could potentially reduce patients’ need for ventilators and optimize resource utilization. DISCLOSURES No relevant relationships by Wei-cheng Chen, source=Web Response No relevant relationships by Teressa Ju, source=Web Response No relevant relationships by Chi Chan Lee, source=Web Response No relevant relationships by Hsin-Ti Lin, source=Web Response