Evaluation of Effectiveness and Safety of Dexmedetomidine in non-Mechanically Ventilated COVID-19 Critically ill Patients: A Multicentre Cohort Study.

IF 3 3区 医学 Q2 CRITICAL CARE MEDICINE
Ahmed Basilim, Khalid Eljaaly, Ohoud Aljuhani, Ghazwa B Korayem, Ali F Altebainawi, Wadha J Aldhmadi, Abdulrahman Alissa, Mashael AlFaifi, Abdullah F Alharthi, Ramesh Vishwakarma, Reem Alqahtani, Ghaida D Alahmari, Afnan M Ibn Khamis, Abeer A Alenazi, Aisha Alharbi, Lulwa Alfaraj, Yasser F Alshammari, Marwah I Abdulqader, Mada B Alharbi, Bayan M Alanazi, Atheer E Alhamazani, Khalid Al Sulaiman
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引用次数: 0

Abstract

Background: 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. Method: 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. Results: 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), P = .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), P = .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), P = .80, and beta coefficient - 0.03 (95% CI -0.33, 0.26), P = .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, P = .14, and HR 1.01; 95% CI 0.95, 1.06, P = .90, respectively). Conclusion: 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.

评估右美托咪定在非机械通气的 COVID-19 重症患者中的有效性和安全性:一项多中心队列研究。
背景:右美托咪定(DEX)因其抗焦虑和镇痛特性、较低的谵妄风险和最小的呼吸抑制作用而成为重症患者非常青睐的镇静剂。此外,DEX 还具有抗炎特性,这促使它被用于治疗 COVID-19 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 COVID-19 重症患者使用 DEX 的安全性和有效性。研究方法这项多中心、回顾性队列研究纳入了确诊为 COVID-19 的成年患者,他们都住进了重症监护室,不需要进行有创机械通气(MV)。根据患者在入住 ICU 72 小时内使用 DEX 的情况将其分为两组。主要结果是需要进行有创机械通气的呼吸衰竭,其他结果为次要结果。研究结果经过倾向匹配后,共有 155 名患者被纳入研究。DEX并未减少需要有创人工呼吸的呼吸衰竭(HR 0.66;95% CI (0.28,1.53),P = .33)。然而,与对照组相比,DEX 组的有创 MV 时间在统计学上显著缩短(β系数 (95%CI):- 1.05 (-2.03, -0.07),P = .03)。相比之下,ICU 和住院时间(LOS)与对照组相比无统计学意义(贝塔系数分别为 0.04(95% CI -0.29,0.38),P = .80 和贝塔系数 - 0.03(95% CI -0.33,0.26),P = .81)。此外,两组患者的 30 天死亡率和住院死亡率相似(分别为 HR 1.1; 95% CI 0.97, 1.20, P = .14 和 HR 1.01; 95% CI 0.95, 1.06, P = .90)。结论右美托咪定似乎并不能降低重症患者因呼吸衰竭而必须进行有创机械通气的风险。不过,右美托咪定组患者接受有创机械通气的平均时间较短。未来需要进行干预研究来证实我们的发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Intensive Care Medicine
Journal of Intensive Care Medicine CRITICAL CARE MEDICINE-
CiteScore
7.60
自引率
3.20%
发文量
107
期刊介绍: Journal of Intensive Care Medicine (JIC) is a peer-reviewed bi-monthly journal offering medical and surgical clinicians in adult and pediatric intensive care state-of-the-art, broad-based analytic reviews and updates, original articles, reports of large clinical series, techniques and procedures, topic-specific electronic resources, book reviews, and editorials on all aspects of intensive/critical/coronary care.
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