Dexmedetomidine for Postoperative Delirium
Trial question
What is the role of postoperative sedation with dexmedetomidine in ICU patients after open heart surgery?
Study design
Single center
Single blinded
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 120
120 patients (43 female, 77 male).
Inclusion criteria: adult ICU patients undergoing cardiac surgery.
Key exclusion criteria: preoperative AF; previous history of interventionally treated arrhythmias; second- and third-degree AV block; bradycardia with HR ≤ 50/min; pacemaker; renal or hepatic insufficiency.
Interventions
N=60 dexmedetomidine (continuous infusion at a dose of 0.2-0.7 mcg/kg/hr).
N=60 propofol (continuous infusion at a dose of 1-2 mg/kg/hr).
Primary outcome
Duration of mechanical ventilation
8.8 hours
11 hours
11.0 hours
8.3 hours
5.5 hours
2.8 hours
0.0 hours
Dexmedetomidine
Propofol
Significant
decrease ▼
Significant decrease in duration of mechanical ventilation (8.8 hours vs. 11 hours; AD -2.2 hours, 95% CI -3.51 to -0.89).
Secondary outcomes
No significant difference in ICU length of stay (1.1 days vs. 1.2 days; AD -0.1 days, 95% CI -0.34 to 0.14).
No significant difference in hospital length of stay (7.4 days vs. 7.4 days; RR 1, 95% CI -76794.23 to 76796.23).
Borderline significant decrease in postoperative delirium (11.7% vs. 25%; RR 0.47, 95% CI -0.02 to 0.96).
Conclusion
In adult ICU patients undergoing cardiac surgery, dexmedetomidine was superior to propofol with respect to duration of mechanical ventilation.
Reference
M Preveden, R Zdravković, S Vicković et al. Dexmedetomidine vs. propofol sedation reduces the duration of mechanical ventilation after cardiac surgery - a randomized controlled trial. Eur Rev Med Pharmacol Sci. 2023 Aug;27(16):7644-7652.
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