Department of Respiratory Diseases, The Third People's Hospital of Shenzhen, the Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518112, Guangdong, PR China.
Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
BMC Pulm Med. 2020 Feb 17;20(1):42. doi: 10.1186/s12890-020-1065-6.
Because of its analgesic and light sedative properties, the highly selective alpha-2 adrenergic receptor agonist dexmedetomidine (DEX) has been suggested for the treatment of septic patients, but its effect on the duration of mechanical ventilation remains unclear. The present study was conducted to review the extant literature in DEX and determine its influence on ventilation time in adult septic patients.
Databases of PubMed, Cochrane, and EMBASE were applied till 20th January 2019 without language restriction. The searching strategy as following: sepsis OR septic AND mechanical ventilation AND dexmedetomidine. Two authors screened titles, abstracts, and even articles to meet the including criterion independently. In addition, references of related articles or reviews were also referred. Data was recorded in a table and analyzed using the software of Review Manager 5.0.
Four studies with a total of 349 patients were included. Three trials with 267 patients revealed the effect of DEX on duration of mechanical ventilation, two trials with 264 patients on ventilator-free days and four trials with 334 patients on 28-day mortality. The analyzed results indicated that DEX was not associated with significantly different durations of mechanical ventilation (MD 0.65, 95% CI, - 0.13 to 1.42, P = 0.10). However, there were significant differences in ventilator-free days (MD 3.57, 95% CI, 0.26 to 6.89, P = 0.03) and 28-day mortality (RR 0.61, 95% CI, 0.49 to 0.94, P = 0.02) in the septic patients.
Administration of DEX for sedation in septic patients was not associated with the duration of mechanical ventilation, but it increased the ventilator-free days and reduced 28-day mortality.
由于其镇痛和轻度镇静特性，高度选择性的 α-2 肾上腺素能受体激动剂右美托咪定（DEX）已被建议用于治疗脓毒症患者，但它对机械通气时间的影响尚不清楚。本研究旨在回顾 DEX 的现有文献，并确定其对成年脓毒症患者通气时间的影响。
我们无语言限制地检索了 PubMed、Cochrane 和 EMBASE 数据库，检索时间截至 2019 年 1 月 20 日。检索策略如下：脓毒症或败血症 AND 机械通气 AND 右美托咪定。两名作者独立筛选标题、摘要甚至文章以符合纳入标准。此外，还参考了相关文章或综述的参考文献。将数据记录在表格中，并使用 Review Manager 5.0 软件进行分析。
共有 4 项研究，共 349 名患者纳入。其中 3 项研究（267 名患者）报告了 DEX 对机械通气时间的影响，2 项研究（264 名患者）报告了 DEX 对无机械通气天数的影响，4 项研究（334 名患者）报告了 DEX 对 28 天死亡率的影响。分析结果表明，DEX 与机械通气时间无显著差异（MD 0.65，95%CI，-0.13 至 1.42，P=0.10）。然而，在无机械通气天数（MD 3.57，95%CI，0.26 至 6.89，P=0.03）和 28 天死亡率（RR 0.61，95%CI，0.49 至 0.94，P=0.02）方面，DEX 治疗组与对照组之间存在显著差异。
DEX 镇静治疗脓毒症患者与机械通气时间无关，但可增加无机械通气天数并降低 28 天死亡率。
