Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines.
College of Medicine, Our Lady of Fatima University, Valenzuela, Philippines.
Ann Pharmacother. 2023 Jun;57(6):696-705. doi: 10.1177/10600280221130458. Epub 2022 Oct 18.
To investigate whether dexmedetomidine (DEX), as adjunctive therapy to benzodiazepine (BZD), is superior to BZD alone in critically ill patients with alcohol withdrawal syndrome (AWS).
PubMed Central, Cochrane CENTRAL, ClinicalTrials.gov and Google Scholar were used as search databases. Specific keywords and MeSH terms were "dexmedetomidine," "benzodiazepine," and "alcohol withdrawal syndrome." The last search was on September 16, 2022.
Randomized controlled trials (RCTs) and nonrandomized/cohort studies exploring the use of DEX in the management of AWS were included. A total of 12 studies were included in the systematic review and 7 in the meta-analysis.
The intensive care unit length of stay (ICU LOS) was found to have a mean difference (MD) of 48.06 [37.48, 58.64], = <0.001 for the cohort subgroup, significantly favoring the DEX arm, but, in contrast, pooled RCT data showed a result of -20.07 [-36.86, -3.28], = 0.02, a shorter ICU LOS for the DEX arm. Bradycardia and hypotension incidence significantly favored the BZD arm in both subgroups. This study compares the effectiveness of adjunctive DEX in clinical practice and aims to help providers in critical decision-making by compiling and analyzing the best current available evidence of its use in AWS.
Based on low to very low level of evidence, adjunctive DEX showed no significant difference for ICU LOS when compared with BZD alone. Pooled randomized trials potentially show a benefit but are similarly limited by their low quality of evidence.
探讨右美托咪定（DEX）作为苯二氮䓬类药物（BZD）的辅助治疗，是否优于单独使用 BZD 治疗酒精戒断综合征（AWS）患者。
使用 PubMed Central、Cochrane CENTRAL、ClinicalTrials.gov 和 Google Scholar 作为搜索数据库。使用的特定关键词和 MeSH 术语是“dexmedetomidine”、“benzodiazepine”和“alcohol withdrawal syndrome”。最后一次搜索是在 2022 年 9 月 16 日。
纳入了探讨 DEX 在 AWS 管理中应用的随机对照试验（RCT）和非随机/队列研究。系统评价共纳入 12 项研究，荟萃分析纳入 7 项研究。
发现重症监护病房（ICU）住院时间（LOS）的均数差值（MD）为 48.06 [37.48, 58.64]，= <0.001，队列亚组显著有利于 DEX 组，但相反，汇总的 RCT 数据显示结果为-20.07 [-36.86, -3.28]，= 0.02，DEX 组的 ICU LOS 更短。心动过缓和低血压的发生率在两个亚组中均显著有利于 BZD 组。本研究比较了辅助 DEX 在临床实践中的有效性，旨在通过编译和分析其在 AWS 中使用的最佳现有证据，帮助提供者做出关键决策。
基于低至极低水平的证据，与单独使用 BZD 相比，辅助 DEX 对 ICU LOS 没有显著差异。汇总的随机试验可能显示出获益，但同样受到证据质量低的限制。
