Recently, several randomized, blinded trials have assessed the comparative effect of dexmedetomidine with propofol in septic patients. However, the results remain controversial regarding mortality, length of ICU stay, and incidence of adverse events. To prove this, it is necessary to systematically evaluate the effectiveness and safety of dexmedetomidine and propofol in the treatment of sepsis in patients on ventilators.
The following is a study that aims to assess the effect of dexmedetomidine with propofol in septic adult patients who are on a ventilator. The design and method is a meta-analysis by collecting data from the NCBI PUBMED database, Cochrane Library, Embase, China National Knowledge Internet (CNKI), and China Biological Medicine (CBM). From these data collected 15 studies that meet the inclusion criteria with the number of subjects as many as 1417 patients. The results showed that compared to propofol, dexmedetomidine did not reduce the risk of mortality up to 28 days [risk ratios (RR) = 0.97, 95% confidence interval (CI) = 0.83–1.13, p=0.70].
However, from the analysis it was found that dexmedetomidine can reduce the length of stay in the ICU {standard mean difference (SMD): 0.15; 95% CI: [−0.30 – (−0.01)], p=0.03}, duration of ventilator use {SMD: 0.22; 95% CI: [−0.44 –(−0.01)], p=0.043}, organ damage assessed using SOFA score {SMD: 0.41; 95% CI: [−0.73–(−0.09)], p=0.013}, interleukin-6 levels at 24 hours (SMD: 2.53; 95% CI: 5.30 – 0.24 , p=0.074), and CK-MB levels at 72 hours {SMD: 0.45; 95% CI: [−0.83 – (−0.08)], p=0.017}.
These data indicate that there is no difference between dexmedetomidine and propofol in reducing the risk of mortality at 28 days in sepsis patients using ventilators. Meanwhile, the length of stay in the ICU, the length of use of the ventilator, organ damage, interleukin-6 and CK-MB levels were lower in dexmedetomdine.
Image: Illustration (source: https://stock.adobe.com/id/)
Reference:
Huang P, Zheng X, Liu Z, Fang X. Dexmedetomidine versus propofol for patients with sepsis requiring mechanical ventilation: A systematic review and meta-analysis. Frontiers in Pharmacology 2021;12:717023.
