Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
Department of Digital Healthcare, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
JAMA Netw Open. 2023 Apr 3;6(4):e239955. doi: 10.1001/jamanetworkopen.2023.9955.
Dexmedetomidine is a widely used sedative in the intensive care unit (ICU) and has unique properties that may be associated with reduced occurrence of new-onset atrial fibrillation (NOAF).
To investigate whether the use of dexmedetomidine is associated with the incidence of NOAF in patients with critical illness.
DESIGN, SETTING, AND PARTICIPANTS: This propensity score-matched cohort study was conducted using the Medical Information Mart for Intensive Care-IV database, which includes records of patients admitted to the ICU at Beth Israel Deaconess Medical Center in Boston dating 2008 through 2019. Included patients were those aged 18 years or older and hospitalized in the ICU. Data were analyzed from March through May 2022.
Patients were divided into 2 groups according to dexmedetomidine exposure: those who received dexmedetomidine within 48 hours after ICU admission (dexmedetomidine group) and those who never received dexmedetomidine (no dexmedetomidine group).
The primary outcome was the occurrence of NOAF within 7 days of ICU admission, as defined by the nurse-recorded rhythm status. Secondary outcomes were ICU length of stay, hospital length of stay, and in-hospital mortality.
This study included 22 237 patients before matching (mean [SD] age, 65.9 [16.7] years; 12 350 male patients [55.5%]). After 1:3 propensity score matching, the cohort included 8015 patients (mean [SD] age, 61.0 [17.1] years; 5240 males [65.4%]), among whom 2106 and 5909 patients were in the dexmedetomidine and no dexmedetomidine groups, respectively. Use of dexmedetomidine was associated with a decreased risk of NOAF (371 patients [17.6%] vs 1323 patients [22.4%]; hazard ratio, 0.80; 95% CI, 0.71-0.90). Although patients in the dexmedetomidine group had longer median (IQR) length of stays in the ICU (4.0 [2.7-6.9] days vs 3.5 [2.5-5.9] days; P < .001) and hospital (10.0 [6.6-16.3] days vs 8.8 [5.9-14.0] days; P < .001), dexmedetomidine was associated with decreased risk of in-hospital mortality (132 deaths [6.3%] vs 758 deaths [12.8%]; hazard ratio, 0.43; 95% CI, 0.36-0.52).
This study found that dexmedetomidine was associated with decreased risk of NOAF in patients with critical illness, suggesting that it may be necessary and warranted to evaluate this association in future clinical trials.
右美托咪定是 ICU 中广泛使用的镇静剂，具有独特的特性，可能与新发心房颤动（NOAF）的发生减少有关。
研究右美托咪定的使用是否与危重病患者的 NOAF 发生率有关。
设计、设置和参与者：本倾向评分匹配队列研究使用了包含 2008 年至 2019 年期间在波士顿贝斯以色列女执事医疗中心 ICU 住院患者记录的医疗信息集市-IV 数据库进行。纳入的患者年龄为 18 岁或以上，并在 ICU 住院。数据分析于 2022 年 3 月至 5 月进行。
根据右美托咪定暴露情况，患者分为两组：ICU 入院后 48 小时内接受右美托咪定的患者（右美托咪定组）和从未接受过右美托咪定的患者（无右美托咪定组）。
主要结局是 ICU 入院后 7 天内发生的 NOAF，定义为护士记录的节律状态。次要结局是 ICU 住院时间、医院住院时间和院内死亡率。
在匹配前，这项研究纳入了 22237 名患者（平均[SD]年龄 65.9[16.7]岁；男性 12350 名[55.5%]）。经过 1:3 倾向评分匹配后，队列纳入了 8015 名患者（平均[SD]年龄 61.0[17.1]岁；男性 5240 名[65.4%]），其中右美托咪定组和无右美托咪定组分别有 2106 名和 5909 名患者。使用右美托咪定与新发心房颤动风险降低相关（371 名患者[17.6%] vs 1323 名患者[22.4%]；风险比，0.80；95%CI，0.71-0.90）。尽管右美托咪定组患者 ICU 中位（IQR）住院时间较长（4.0[2.7-6.9]天 vs 3.5[2.5-5.9]天；P < .001）和医院住院时间较长（10.0[6.6-16.3]天 vs 8.8[5.9-14.0]天；P < .001），但右美托咪定与降低院内死亡率风险相关（132 例死亡[6.3%] vs 758 例死亡[12.8%]；风险比，0.43；95%CI，0.36-0.52）。
本研究发现，右美托咪定与危重病患者新发心房颤动风险降低相关，表明在未来的临床试验中，有必要和有必要评估这种关联。
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