期刊
BMC MEDICINE
卷 19, 期 1, 页码 -出版社
BMC
DOI: 10.1186/s12916-021-02175-2
关键词
Dexmedetomidine; Post-intensive care syndrome; Cardiac surgery; Critical illness; Prediction
资金
- Cardiovascular Multidisciplinary Integrated Research Fund [CIMF-Z-2016-23-1823]
- Comfort medical research fund of Shandong Medical Association [YXH2020ZX026]
- Clinical Science and Technology Innovation Program of Jinan City [201805040]
- Medicine and Health Science Technology Development of Shandong Province [2017WS191]
This study found that prophylactic nocturnal administration of Dexmedetomidine significantly reduced the incidence of PICS following cardiac surgery, particularly reducing the occurrence of psychological impairments. However, this treatment was also associated with a higher rate of hypotension.
Background: Dexmedetomidine is a sedative agent that may have the potential to reduce the risk of post-intensive care syndrome (PICS). This study aimed to establish whether prophylactic nocturnal dexmedetomidine safely reduces postoperative PICS incidence and to develop an easy-to-use model for predicting the risk of PICS following cardiac surgery. Methods: This was a single-center, double-blind, randomized, prospective, placebo-controlled trial. Patients undergoing cardiac surgery were randomly assigned (1:1) to dexmedetomidine or placebo (normal saline) groups between January 2019 and July 2020. Dexmedetomidine or a similar volume of saline was administered, with an infusion rate up to 1.2 mu g/kg/h until the RASS remained between - 1 and 0. The primary study endpoint was PICS incidence at 6 months follow-up, as defined by cognitive, physical, or psychological impairments. Results: We assessed 703 individuals for eligibility, of whom 508 were enrolled. Of these, there were 251 in the dexmedetomidine group and 257 in the placebo group that received the trial agent, forming a modified intention-to-treat population. PICS incidence at 6-month follow-up was significantly decreased in the dexmedetomidine group (54/251, 21.5%) relative to the placebo group (80/257, 31.1%) (odds ratio [OR] 0.793, 95% CI 0.665-0.945; p = 0.014). Psychological impairment was significantly reduced in the dexmedetomidine group relative to the placebo group (18.7% vs. 26.8%, OR 0.806, CI 0.672-0.967, p = 0.029). However, dexmedetomidine treatment was associated with a higher rate of hypotension. A nomogram revealed that age, education, a medical history of diabetes and smoking, dexmedetomidine treatment, postoperative atrial fibrillation, and sequential organ failure assessment scores at 8 h post-surgery were independent predictors of PICS. Conclusions: Prophylactic nocturnal dexmedetomidine administration significantly reduced PICS incidence by a marked reduction in psychological impairment within a 6-month follow-up period.
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