Serpa Neto Ary, Young Marcus, Phongphithakchai Atthaphong, Maeda Akinori, Hikasa Yukiko, Pattamin Nuttapol, Kitisin Nuanprae, Premaratne Gehan, Chan Gabriel, Furler Joseph, Stevens Meg, Pandey Dinesh, Jahanabadi Hossein, Shehabi Yahya, Bellomo Rinaldo
Department of Intensive Care, Austin Hospital - Melbourne, Australia.
Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital - Melbourne, Australia.
Crit Care Sci. 2025 Mar 24;37:e20250010. doi: 10.62675/2965-2774.20250010. eCollection 2025.
Agitation is a major problem in the intensive care unit. However, no treatment has clearly emerged as effective and safe. Using target trial emulation, we aimed to test the hypothesis that early intervention with dexmedetomidine would accelerate agitation resolution.
We read clinical notes in an electronic medical records system with natural language processing to identify patients with agitation. We obtained their demographics, trajectories, associations, and outcomes. We used g-formulas to study the possible effects of dexmedetomidine on agitation resolution and key outcomes.
We screened 7525 patients. Overall, 2242 patients (29.8%) developed within-intensive care unit agitation, and 2052 (27.3%) were eligible for inclusion in the target trial emulation, with 314 treated with dexmedetomidine. Dexmedetomidine-treated patients had more severe illness and were more likely to have unplanned emergency admissions with medical diagnoses. However, they achieved higher rates of resolution of within-intensive care unit agitation (94% versus 72%; p < 0.001) and lower 30-day mortality (5% versus 9%; p = 0.033). Early initiation of dexmedetomidine accelerated the resolution of agitation (risk ratio [RR] 1.13 [95%CI 1.03 - 1.21]; risk difference [RD] 9.8% [95%CI 2.6% - 15.4%]); extubation by Day 30 (RR 1.03 [95%CI 1.02 - 1.04]; RD 3.1% [95%CI 2.2% - 4.2%]); and reduced the chance of having a tracheostomy by Day 30 (RR 0.67 [95%CI 0.34 - 0.99]; RD -3.5% [95%CI -7.0% - -0.0%]).
Through target trial emulation analysis, early dexmedetomidine was associated with an increased rate of resolution of agitation and extubation and decreased tracheostomy risk.
躁动是重症监护病房的一个主要问题。然而，目前尚无明确有效的安全治疗方法。我们采用目标试验模拟法，旨在检验早期使用右美托咪定干预可加速躁动缓解这一假设。
我们通过自然语言处理技术读取电子病历系统中的临床记录，以识别躁动患者。我们获取了他们的人口统计学信息、病程、相关因素及结局。我们使用g公式研究右美托咪定对躁动缓解及关键结局的可能影响。
我们筛查了7525例患者。总体而言，2242例患者（29.8%）在重症监护病房内出现躁动，2052例（27.3%）符合纳入目标试验模拟的条件，其中314例接受了右美托咪定治疗。接受右美托咪定治疗的患者病情更严重，更有可能因医学诊断而进行非计划紧急入院。然而，他们在重症监护病房内躁动缓解率更高（94%对72%；p<0.001），30天死亡率更低（5%对9%；p = 0.033）。早期开始使用右美托咪定可加速躁动缓解（风险比[RR]1.13[95%CI 1.03 - 1.21]；风险差[RD]9.8%[95%CI 2.6% - 15.4%]）；在第30天拔管（RR 1.03[95%CI 1.02 - 1.04]；RD 3.1%[95%CI 2.2% - 4.2%]）；并降低了第30天进行气管切开术的可能性（RR 0.67[95%CI 0.34 - 0.99]；RD -3.5%[95%CI -7.0% - -0.0%]）。
通过目标试验模拟分析，早期使用右美托咪定与躁动缓解率和拔管率增加以及气管切开术风险降低相关。
