Enomoto Yuki, Iwagami Masao, Tsuchiya Asuka, Morita Kojiro, Abe Toshikazu, Kido Takahiro, Uda Kazuaki, Inokuchi Ryota, Yasunaga Hideo, Inoue Yoshiaki, Tamiya Nanako
Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan.
Health Services Research & Development Centre, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan.
Burns. 2021 Nov;47(7):1502-1510. doi: 10.1016/j.burns.2021.05.003. Epub 2021 May 12.
Dexmedetomidine is an alpha 2-adrenergic receptor agonist. Apart from its sedative effects, dexmedetomidine can potentially reduce mortality through its anti-inflammatory effect. However, the impact of dexmedetomidine on in-hospital outcomes of patients with severe burns remains unclear. Therefore, we aimed to elucidate the association between dexmedetomidine use and mortality in mechanically ventilated patients with severe burns, using a Japanese nationwide database of in-hospital patients.
We included adults with severe burns (burn index ≥ 10) who were registered in the Japanese Diagnosis Procedure Combination national inpatient database from 2010 to 2018, started mechanical ventilation within 3 days of admission, and received any sedative drug (dexmedetomidine, midazolam, or propofol). One-to-one propensity score matching was performed between patients who received dexmedetomidine on the day of mechanical ventilation initiation (dexmedetomidine group) and those who did not receive dexmedetomidine (control group). The primary outcome was all-cause 30-day in-hospital mortality. Secondary outcomes were length of hospital stay and duration of mechanical ventilation in patients and survivors.
Eligible patients (n = 1888) were classified into the dexmedetomidine group (n = 371) or the control group (n = 1517). After one-to-one propensity score matching, we compared 329 patients from both groups. No significant difference was observed in the 30-day mortality between patients in the dexmedetomidine and control groups (22.8% vs. 22.5%, respectively; odds ratio, 1.02; 95% confidence interval, 0.71-1.46). Moreover, there were no significant differences between patients in the dexmedetomidine and control groups in terms of the length of hospital stay or the duration of mechanical ventilation.
We found no significant association between dexmedetomidine use and in-hospital outcomes (mortality, length of hospital stay, and length of mechanical ventilation) in mechanically ventilated patients with severe burns. Dexmedetomidine use may not improve the aforementioned outcomes; therefore, its selection should be based on the patient's general condition and the target level of sedation.
右美托咪定是一种α2肾上腺素能受体激动剂。除了具有镇静作用外，右美托咪定还可能通过其抗炎作用降低死亡率。然而，右美托咪定对严重烧伤患者院内结局的影响仍不明确。因此，我们旨在利用日本全国范围内的住院患者数据库，阐明右美托咪定的使用与机械通气的严重烧伤患者死亡率之间的关联。
我们纳入了2010年至2018年在日本诊断程序组合全国住院患者数据库中登记的严重烧伤成人患者（烧伤指数≥10），这些患者在入院后3天内开始机械通气，并接受了任何镇静药物（右美托咪定、咪达唑仑或丙泊酚）。在机械通气开始当天接受右美托咪定的患者（右美托咪定组）和未接受右美托咪定的患者（对照组）之间进行一对一倾向评分匹配。主要结局是全因30天院内死亡率。次要结局是患者和幸存者的住院时间和机械通气时间。
符合条件的患者（n = 1888）被分为右美托咪定组（n = 371）或对照组（n = 1517）。在进行一对一倾向评分匹配后，我们比较了两组的329例患者。右美托咪定组和对照组患者的30天死亡率无显著差异（分别为22.8%和22.5%；优势比，1.02；95%置信区间，0.71 - 1.46）。此外，右美托咪定组和对照组患者在住院时间或机械通气时间方面也无显著差异。
我们发现右美托咪定的使用与机械通气的严重烧伤患者的院内结局（死亡率、住院时间和机械通气时间）之间无显著关联。使用右美托咪定可能无法改善上述结局；因此，其选择应基于患者的一般状况和目标镇静水平。
