Nakashima Tsuyoshi, Miyamoto Kyohei, Shima Nozomu, Kato Seiya, Kawazoe Yu, Ohta Yoshinori, Morimoto Takeshi, Yamamura Hitoshi
1Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama Japan.
2Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai City, Japan.
J Intensive Care. 2020 Jan 2;8:1. doi: 10.1186/s40560-019-0415-z. eCollection 2020.
Dexmedetomidine has been reported to improve organ dysfunction in critically ill patients. In a recent randomized controlled trial (Dexmedetomidine for Sepsis in Intensive Care Unit (ICU) Randomized Evolution [DESIRE]), we demonstrated that dexmedetomidine was associated with reduced mortality risk among patients with severe sepsis. We performed this exploratory sub-analysis to examine the mechanism underlying improved survival in patients sedated with dexmedetomidine.
The DESIRE trial compared a sedation strategy with and without dexmedetomidine among 201 mechanically ventilated adult patients with sepsis across eight ICUs in Japan. In the present study, we included 104 patients with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of ≥ 23 (54 in the dexmedetomidine [DEX] group and 50 in the non-dexmedetomidine [non-DEX] group). Initially, we compared the changes in the sequential organ failure assessment (SOFA) scores from the baseline within 6 days after randomization between groups. Subsequently, we evaluated the variables comprising the organ component of the SOFA score that showed relevant improvement in the initial comparison.
The mean patient age was 71.0 ± 14.1 years. There was no difference in the median APACHE II score between the two groups (29 [interquartile range (IQR), 25-31] vs. 30 [IQR, 25-33]; = 0.35). The median SOFA score at the baseline was lower in the DEX group (9 [IQR, 7-11] vs. 11 [IQR, 9-13]; = 0.01). While the renal SOFA subscore at the baseline was similar for both groups, it significantly decreased in the DEX group on day 4 ( = 0.02). During the first 6 days, the urinary output was not significantly different ( = 0.09), but serum creatinine levels were significantly lower ( = 0.04) in the DEX group. The 28-day and in-hospital mortality rates were significantly lower in the DEX group (22% vs. 42%; = 0.03, 28% vs. 52%; = 0.01, respectively).
A sedation strategy with dexmedetomidine is associated with improved renal function and decrease mortality rates among patients with severe sepsis.
This trial was registered on ClinicalTrials.gov (NCT01760967) on January 1, 2013.
据报道，右美托咪定可改善危重症患者的器官功能障碍。在最近一项随机对照试验（重症监护病房右美托咪定治疗脓毒症随机演进试验[DESIRE]）中，我们证明右美托咪定与严重脓毒症患者死亡风险降低相关。我们进行了这项探索性亚组分析，以研究接受右美托咪定镇静的患者生存改善的潜在机制。
DESIRE试验在日本8个重症监护病房中，对201例接受机械通气的成年脓毒症患者比较了使用和不使用右美托咪定的镇静策略。在本研究中，我们纳入了急性生理与慢性健康状况评分II（APACHE II）≥23分的104例患者（右美托咪定[DEX]组54例，非右美托咪定[非DEX]组50例）。最初，我们比较了两组在随机分组后6天内序贯器官衰竭评估（SOFA）评分相对于基线的变化。随后，我们评估了在初始比较中显示有相关改善的构成SOFA评分器官部分的变量。
患者平均年龄为71.0±14.1岁。两组间APACHE II评分中位数无差异（29[四分位间距（IQR），25 - 31]对30[IQR，25 - 33]；P = 0.35）。DEX组基线时SOFA评分中位数较低（9[IQR，7 - 11]对11[IQR，9 - 13]；P = 0.01）。虽然两组基线时肾脏SOFA子评分相似，但DEX组在第4天显著降低（P = 0.02）。在最初6天内，尿量无显著差异（P = 0.09），但DEX组血清肌酐水平显著较低（P = 0.04）。DEX组28天和住院死亡率显著较低（分别为22%对42%；P = 0.03，28%对52%；P = 0.01）。
右美托咪定镇静策略与严重脓毒症患者肾功能改善及死亡率降低相关。
本试验于2013年1月1日在ClinicalTrials.gov（NCT01760967）注册。
