Prognosis of dexmedetomidine sedation in patients with sepsis: a systematic review and meta-analysis.

Abstract

Introduction: Sepsis is a life-threatening organ dysfunction, caused by a dysfunctional host immune response to infection. This meta-analysis evaluates the effects of dexmedetomidine on mortality, organ function, and inflammation in sepsis patients.

Evidence acquisition: Prospective controlled trials of sepsis patients receiving dexmedetomidine sedation were included from five databases up to May 2024. The experimental group was sedated with dexmedetomidine, while the control group received other sedatives. STATA 15.1 was used for analysis. Relative risk (RR) and standardized mean difference (SMD) with 95% confidence intervals (CI) were calculated.

Evidence synthesis: Eleven trials involving 1245 sepsis patients (620 experimental, 625 control) were included. Dexmedetomidine significantly improved mortality (RR=0.69, 95%CI: 0.58, 0.81) but did not affect ICU length of stay (SMD=-0.07, 95%CI: -0.19, 0.05). It did not significantly impact mechanical ventilation duration (SMD=0.02, 95%CI: -0.29, 0.33) but reduced creatinine levels (SMD=-0.99, 95%CI: -1.88, -0.09) and cystatin C levels (SMD=-1.31, 95%CI: -2.25, -0.37). Dexmedetomidine did not reduce continuous blood purification use (RR=1.14, 95%CI: 0.80, 1.61). The overall SOFA score showed an improvement trend (SMD=-0.15, 95%CI: -0.36, 0.05), with significant improvement in kidney scores on day 4 and day 6 (Day 4: SMD=-0.66, 95%CI: -1.10, -0.21; Day 6: SMD=-0.65, 95%CI: -1.09, -0.21). Dexmedetomidine decreased 24-hour TNF-α (SMD=-0.63, 95%CI: -0.84, -0.42) and IL-1 levels (SMD=-0.86, 95%CI: -1.10, -0.61), but also IL-6 levels (SMD=-0.83, 95%CI: -1.16, -0.51).

Conclusions: Dexmedetomidine reduces mortality and inflammation in sepsis patients, improving renal function, but does not shorten ICU stay or significantly affect other organ functions.