Basilim Ahmed, Eljaaly Khalid, Aljuhani Ohoud, Korayem Ghazwa B, Altebainawi Ali F, Aldhmadi Wadha J, Alissa Abdulrahman, AlFaifi Mashael, Alharthi Abdullah F, Vishwakarma Ramesh, Alqahtani Reem, Alahmari Ghaida D, Ibn Khamis Afnan M, Alenazi Abeer A, Alharbi Aisha, Alfaraj Lulwa, Alshammari Yasser F, Abdulqader Marwah I, Alharbi Mada B, Alanazi Bayan M, Alhamazani Atheer E, Al Sulaiman Khalid
Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
J Intensive Care Med. 2025 Jan;40(1):74-84. doi: 10.1177/08850666241268498. Epub 2024 Nov 18.
Dexmedetomidine (DEX) is a highly favored sedative agent in critically ill patients owing to its anxiolytic and analgesic properties, lower risk of delirium, and minimal respiratory depression. Additionally, DEX exhibits anti-inflammatory properties, which have prompted its use in managing COVID-19 patients to mitigate cytokine storm and multi-organ dysfunction. Thus, this study aims to evaluate the safety and effectiveness of DEX use in critically ill patients with COVID-19. This multicenter, retrospective cohort study included adult patients with confirmed COVID-19 who were admitted to the ICUs and did not require invasive mechanical ventilation (MV). Patients were categorized into two groups based on receiving DEX use within 72 h of ICU admission. The primary outcome was respiratory failure requiring invasive MV; other outcomes were considered secondary. A total of 155 patients were included in the study after propensity matching. DEX did not reduce respiratory failure requiring invasive MV (HR 0.66; 95% CI (0.28, 1.53), = .33). However, the time for invasive MV was statistically significantly shorter in the DEX group compared with the control group (beta coefficient (95%CI): - 1.05 (-2.03, -0.07), = .03). In contrast, ICU and hospital Length of stay (LOS) were not statistically significant compared to the control group (beta coefficient 0.04 (95% CI -0.29, 0.38), = .80, and beta coefficient - 0.03 (95% CI -0.33, 0.26), = .81, respectively). In addition, the 30-day and in-hospital mortality rates were similar between the two groups (HR 1.1; 95% CI 0.97, 1.20, = .14, and HR 1.01; 95% CI 0.95, 1.06, = .90, respectively). Dexmedetomidine did not appear to lower the risk of respiratory failure necessitating invasive mechanical ventilation in critically ill patients. However, the mean time for invasive mechanical ventilation was shorter in the DEX group. Future interventional studies are required to confirm our findings.
右美托咪定（DEX）因其具有抗焦虑和镇痛特性、谵妄风险较低以及呼吸抑制作用最小，而成为重症患者中备受青睐的镇静剂。此外，DEX具有抗炎特性，这促使其用于治疗新冠肺炎患者，以减轻细胞因子风暴和多器官功能障碍。因此，本研究旨在评估DEX用于新冠肺炎重症患者的安全性和有效性。这项多中心回顾性队列研究纳入了确诊为新冠肺炎且入住重症监护病房（ICU）且不需要有创机械通气（MV）的成年患者。根据在ICU入院72小时内是否使用DEX，将患者分为两组。主要结局是需要有创MV的呼吸衰竭；其他结局视为次要结局。经过倾向匹配后，共有155例患者纳入研究。DEX并未降低需要有创MV的呼吸衰竭发生率（风险比[HR]为0.66；95%置信区间[CI]为[0.28, 1.53]，P = 0.33）。然而，与对照组相比，DEX组有创MV的时间在统计学上显著更短（β系数[95%CI]：-1.05[-2.03, -0.07]，P = 0.03）。相比之下，与对照组相比，ICU住院时间和住院总时长（LOS）在统计学上无显著差异（β系数分别为0.04[95%CI -0.29, 0.38]，P = 0.80；以及β系数为-0.03[95%CI -0.33, 0.26]，P = 0.81）。此外，两组的30天和住院死亡率相似（HR分别为1.1；95%CI为0.97, 1.20，P = 0.14；以及HR为1.01；95%CI为0.95, 1.06，P = 0.90）。右美托咪定似乎并未降低重症患者需要有创机械通气的呼吸衰竭风险。然而，DEX组有创机械通气的平均时间更短。未来需要进行干预性研究以证实我们的发现。
