Key result
Perioperative dexmedetomidine shortens mechanical ventilation by ~2.2 hours after pediatric cardiac surgery.
Why the study?
Does perioperative dexmedetomidine reduce the duration of mechanical ventilation in paediatric patients undergoing cardiac surgery?
Meta-Analysis (n=837)
Does perioperative dexmedetomidine reduce the duration of mechanical ventilation in paediatric patients undergoing cardiac surgery?
Mean Difference: -2.2 (95% CI -3.51–-0.9)
p-value: p=0.001
Perioperative dexmedetomidine in pediatric cardiac surgery significantly reduces the duration of mechanical ventilation, ICU and hospital length of stay, and the incidence of junctional ectopic tachycardia.
Supports perioperative dexmedetomidine to shorten ventilation time in pediatric cardiac surgery; confirms pooled benefit in Level 1 meta-analysis.
OBJECTIVES: Dexmedetomidine has been shown to decrease cardiac complications in adults undergoing cardiac surgery. Results from clinical trials of dexmedetomidine on outcomes following paediatric cardiac surgery are controversial. METHODS: We searched EMBASE, PubMed and Cochrane CENTRAL databases for randomized controlled trials comparing the effect of dexmedetomidine versus placebo or other anaesthetic drugs in paediatric patients undergoing cardiac surgery. The primary outcome was the duration of mechanical ventilation. The secondary outcomes were intensive care unit stay, hospital length of stay (LOS), incidence of junctional ectopic tachycardia and postoperative deaths. RESULTS: Nine trials with a total of 837 patients were selected. Compared with controls, dexmedetomidine significantly reduced the postoperative duration of mechanical ventilation [in hours; n = 837; weighted mean difference -2.20, 95% confidence interval (CI) -3.51 to -0.90; P = 0.001; I2 = 97%], intensive care unit LOS (in days; n = 737; weighted mean difference -0.47, 95% CI -0.90 to -0.03; P = 0.03; I2 = 97%) and hospital LOS (in days; n = 291; weighted mean difference -1.80, 95% CI -3.36 to -0.25; P = 0.02; I2 = 96%). Dexmedetomidine also significantly reduced the incidence of postoperative junctional ectopic tachycardia (21/292 vs 50/263; risk ratio 0.40, 95% CI 0.25-0.64; P = 0.0001; I2 = 0.0%), but there was no difference between groups in postoperative deaths (4/182 vs 6/153; odds ratio 0.54, 95% CI 0.15-1.93; P = 0.34; I2 = 0.0%). CONCLUSIONS: Perioperative administration of dexmedetomidine to paediatric patients undergoing cardiac surgery may shorten the duration of mechanical ventilation, LOS in the intensive care unit and in the hospital and reduce the incidence of junctional ectopic tachycardia. More high-quality randomized controlled trials are encouraged to verify the beneficial effect of dexmedetomidine before its clinical application in paediatric patients undergoing surgery for congenital heart disease.
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Liu et al. (2018) conducted a meta-analysis in paediatric patients undergoing cardiac surgery (n=837). Dexmedetomidine vs. Placebo or other anaesthetic drugs was evaluated on Duration of mechanical ventilation (in hours) (WMD -2.20, 95% CI -3.51 to -0.90, p=0.001). Perioperative dexmedetomidine significantly reduced the postoperative duration of mechanical ventilation in paediatric cardiac surgery patients (weighted mean difference -2.20 hours; 95% CI -3.51 to -0.90; P=0.001).
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