Dexmedetomidine in prevention and treatment of postoperative and intensive care unit delirium: a systematic review and meta-analysis

Flükiger, Julian; Hollinger, Alexa; Speich, Benjamin; Meier, Vera; Tontsch, Janna; Zehnder, Tatjana; Siegemund, Martin

doi:10.1186/s13613-018-0437-z

Annals of Intensive Care

Table 1 Study characteristics of all included RCTs

From: Dexmedetomidine in prevention and treatment of postoperative and intensive care unit delirium: a systematic review and meta-analysis

	Study	Study location	Study date	Population	Procedure	Control medication	Total number of patients	Mean age (years)	Male (%)	Delirium assessment	Endpoint delirium
Sedation comparison	Chang [52]	Taiwan	2014–2015	Non-cardiac surgery	Postoperatively for a maximum of 24 h, RASS-2-0	Propofol	60	70.5	58.3	CAM-ICU	2
	Lee [55]	South Korea	2016–2017	Non-cardiac surgery	Intraoperatively as continuous infusion or bolus	Placebo	318	73	44.3	CAM	1
	Mei [54]	China	2016–2017	Non-cardiac surgery	Intraoperatively as bolus and subsequent continuous infusion	Propofol	296	75	45.6	CAM	1
	Sheikh [53]	India	2014–2016	Cardiac surgery	Intraoperatively as bolus and subsequent continuous infusion	Propofol	60	34.6	N/A	*	2
	Skrobik [56]	USA	2013–2016	MV**	9:30 in the evening until 6:15 the next morning, continuous infusion without bolus, RASS-1	Placebo	100	62.3	64	ICDSC	1
	Deiner [33]	USA	2008–2014	Non-cardiac surgery	Entering OR until 2 h in recovery room	Placebo	390	74***	48.7	CAM CAM-ICU	1
	Kawazoe [44]	Japan	2013–2016	MV	Continuously until end of MV, RASS-0 by day, RASS-2 by night	Propofol midazolam	201	68.5	63.2	CAM	2
	Li [45]	China	2014–2015	Cardiac surgery	Intraoperatively and continuously until end of MV	Placebo	285	67	69.1	CAM CAM-ICU	1
	Li [43]	China	2015–2016	MV	Sedation for at least 48 h until end of MV, RASS-0–1 in intervention, RASS − 2/− 3 in control group	Propofol, midazolam	126	44	56.3	CAM-ICU	1
	Djaiani [46]	Canada	2011–2014	Cardiac surgery	Postoperatively and continuously until end of MV	Propofol	183	72.6	75.4	CAM CAM-ICU	1
	Liu [47]	China	2015	Cardiac surgery	Postoperatively on ICU admission and continuously until end of MV, RASS-3-0	Propofol	61	54***	41	CAM	2
	Liu [49]	China	2014–2016	Non-cardiac surgery	Intraoperatively until 20 min before end of surgery	Placebo	197	73	48.7	CAM	1
	Su [58]	China	2011–2013	Non-cardiac surgery	Postoperatively until 8:00 the next morning	Placebo	700	74.4	60.4	CAM	1
	MacLaren [50]	USA	2009–2012	MV	Continuously until end of MV, according to desired SAS	Midazolam	23	58.1	56.5	ICDSC	2
	Priye [51]	India	2012–2013	Cardiac surgery	Postoperatively for 12 h	Placebo	64	43.3	51.6	RASS	2
	Yang [34]	China	2013	Non-cardiac surgery	Intraoperatively until 1 h before end of surgery and postoperatively until 6:00 the next morning	Placebo	79	50.5	53.2	CAM-ICU	2
	Devlin [35]	USA	2008–2012	NIV	2 h stable after NIV mask removal, SAS 3–4	Placebo	33	65	51.5	ICDSC	2
	Park [36]	South Korea	2012–2013	Cardiac surgery	Postoperatively until end of MV, RSS 2–3	Remifentanil	142	52.7	55.6	CAM-ICU	1
	Huang [37]	China	2008–2011	NIV	Until end of sedation, RSS 2–3	Midazolam	62	64.5	41.9	N/A	2
	Jakob [38]	Europe + Russia	2007–2010	MV	Continuously until end of MV, RASS-3-0	Propofol, midazolam	998	65***	65.5	CAM-ICU	2
	Maldonado [39]	USA	N/A	Cardiac surgery	Postoperatively until end of MV	Propofol, midazolam	118	57.7	63.6	CAM CAM-ICU	1
	Ruokonen [40]	Switzerland + Finland	N/A	MV	Continuously until end of MV, according to desired RASS	Propofol, midazolam	85	66***	82.4	CAM-ICU	2
	Shehabi [41]	Australia	2004–2007	Cardiac surgery	Postoperatively until ICU discharge, MAAS 2–4	Morphine	299	71.3***	75.3	CAM-ICU	1
	Pandharipande [32]	USA	2004–2006	MV	Continuously until end of MV, according to desired RASS	Lorazepam	103	59.5***	51.5	CAM-ICU	1
	Corbett [42]	USA	2002–2004	Cardiac surgery	Postoperatively until end of MV, RSS 5 the first 2 h, RSS 3–4 afterward	Propofol	89	63	82	N/A	3
Treatment comparison	Reade [57]	Australia + New Zealand	2011–2013	AD (MV)	According to desired RASS = 0	Placebo	74	57.3***	75.7	CAM-ICU	3
	Yapici 2010	Turkey	2005–2007	AD (cardiac surgery)	According to blood pressure and heart rate	Midazolam	72	60	37.5	CAM-ICU	3
	Reade [59]	Australia	2006–2008	AD (MV)	According to desired RASS = 0	Haloperidol	20	60.3***	85	ICDSC	3

Incidence comparison, normal matter; treatment comparison, italic matter
AD agitated delirium, CAM confusion assessment method, CAM-ICU confusion assessment method for intensive care unit, h hours, ICDSC intensive care delirium screening checklist, MAAS Motor Activity Assessment Scale, MV mechanical ventilation, N/A not available, NIV noninvasive ventilation, OR operating room, RASS Richmond Agitation and Sedation Scale, RSS Ramsay Sedation Scale, SAS Riker Sedation and Agitation Scale
1, primary endpoint; 2, secondary endpoint; 3, no specific endpoint
*Delirium defined as shourt course illusions, confusion, and cerebral excitement in the postoperative period; **Most; ***Median age

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