Zhao Shuai, Zhou Ruihui, Zhong Qi, Zhang Mi
Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, China.
Front Pharmacol. 2024 Feb 29;15:1344327. doi: 10.3389/fphar.2024.1344327. eCollection 2024.
Dexmedetomidine is recommended for sedation in patients on mechanical ventilation. Whether age or ICU types could alter mortality in invasive mechanically ventilated patients with sepsis receiving dexmedetomidine is unknown. We included patients with sepsis receiving invasive mechanical ventilation from the Medical Information Mart for Intensive Care IV database. The exposure was intravenous dexmedetomidine administration during ICU stay. The primary outcome was 28-day mortality. The secondary outcomes were the length of ICU stay and liberation from invasive mechanical ventilation. Propensity score matching (PSM) and Cox proportional hazards regression were used to adjust for confounders and investigate any association. Restricted cubic spline models were used to evaluate potential nonlinear associations. The pre-matched and propensity score-matched cohorts included 5,871 and 2016 patients, respectively. In the PSM cohorts, dexmedetomidine exposure was related to lower 28-day mortality (186 [17.7%] . 319 [30.3%]; < 0.001). Patients receiving dexmedetomidine, regardless of whether they were younger (≤65 years; hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.23-0.42; < 0.001) or elderly (>65 years; HR, 0.65; 95% CI, 0.52-0.83; < 0.001), was associated with lower 28-day mortality (61 [10.3%] 168 [28.2%] for younger; 125 [27.2%] 152 [33.0%] for elderly). Patients receiving dexmedetomidine was also associated with lower 28-day mortality (53 [12.6%] 113 [26.5%] for surgical intensive care unit [SICU]; 133 [21.0%] 206 [32.9%] for non-SICU) regardless of whether the first admission to the SICU (HR, 0.36; 95% CI, 0.25-0.50; < 0.001) or non-SICU (HR, 0.50; 95% CI, 0.40-0.62; < 0.001). Moreover, both dose and duration of dexmedetomidine administration were related to lower 28-day mortality than no dexmedetomidine in younger patients ( < 0.001), but it not statistically significant in elderly patients. Dexmedetomidine was associated with lower 28-day mortality in critically ill patients with sepsis receiving invasive mechanical ventilation, regardless of whether patients were younger or elderly, the first admission to the SICU or non-SICU.
右美托咪定被推荐用于接受机械通气患者的镇静。年龄或重症监护病房（ICU）类型是否会改变接受右美托咪定治疗的脓毒症侵袭性机械通气患者的死亡率尚不清楚。我们纳入了重症监护医学信息数据库IV中接受侵袭性机械通气的脓毒症患者。暴露因素为ICU住院期间静脉给予右美托咪定。主要结局为28天死亡率。次要结局为ICU住院时间和脱离侵袭性机械通气。采用倾向评分匹配（PSM）和Cox比例风险回归来调整混杂因素并研究任何关联。使用限制立方样条模型评估潜在的非线性关联。匹配前和倾向评分匹配队列分别包括5871例和2016例患者。在PSM队列中，右美托咪定暴露与较低的28天死亡率相关（186例[17.7%]对319例[30.3%]；P<0.001）。接受右美托咪定治疗的患者，无论年龄较轻（≤65岁；风险比[HR]，0.31；95%置信区间[CI]，0.23 - 0.42；P<0.001）还是年龄较大（>65岁；HR，0.65；95%CI，0.52 - 0.83；P<0.001），均与较低的28天死亡率相关（年龄较轻者中61例[10.3%]对168例[28.2%]；年龄较大者中125例[27.2%]对152例[33.0%]）。接受右美托咪定治疗的患者也与较低的28天死亡率相关（外科重症监护病房[SICU]中53例[12.6%]对113例[26.5%]；非SICU中133例[21.0%]对206例[32.9%]），无论首次入住SICU（HR，0.36；95%CI，0.25 - 0.50；P<0.001）还是非SICU（HR，0.50；95%CI，0.40 - 0.62；P<0.001）。此外，右美托咪定的给药剂量和持续时间均与年龄较轻患者较低的28天死亡率相关（P<0.001），但在年龄较大患者中无统计学意义。右美托咪定与接受侵袭性机械通气的脓毒症重症患者较低的28天死亡率相关，无论患者年龄较轻或较大，首次入住SICU还是非SICU。
