Sensitivity analyses of intensive care unit stay and time to extubation.

<p>The overall analyses using weighted mean differences showed a reduction in intensive care unit stay of −0.79 [−1.17 to −0.40] days and a reduction in time to extubation of −2.74 [−3.80 to −1.65] hours in the dexmedetomidine group. It should be noted that the standard mean differences used in this table is not expressed in days or hours.</p><p>Dex: dexmedetomidine; SMD: standardized mean difference; CI: confidence interval; P: p-value; CABG: coronary artery bypass grafting; ICU: intensive care unit; NIV: non invasive ventilation.</p><p>duration of mechanical ventilation from randomization until patients were free of mechanical ventilation(including noninvasive).</p

Forest plot for the length of ICU stay.

<p>Overall analysis showed that the use of dexmedetomidine was associated with a significant reduction in length of ICU stay (SMD = −0.48 [−0.78 to −0.18] , p for effect = 0.002, p for heterogeneity <0.001, I2 = 91% with 17 studies and 2,424 patients included). ICU = intensive care unit; CI = confidence interval; SMD = standardized mean difference; N = number; SD = standard deviation; Dex = dexmedetomidine.</p

Funnel plot for the length of ICU stay.

<p>Visual inspection of funnel plots did not identify a skewed or asymmetrical shape for the co-primary endpoints. Quantitative evaluation did not suggest a presence of publication bias, as measured by the Egger's test (p = 0.4) and Peters' test (p = 0.6). ICU = intensive care unit; SE = standard error; SMD = standardized mean difference.</p

Dexmedetomidine as a Sedative Agent in Critically Ill Patients: A Meta-Analysis of Randomized Controlled Trials

<div><p>Introduction</p><p>The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time to extubation is still unclear.</p><p>Materials and Methods</p><p>Pertinent studies were independently searched in BioMedCentral, PubMed, Embase, and the Cochrane Central Register of clinical trials (updated February first 2013). Randomized studies (dexmedetomidine versus any comparator) were included if including patients mechanically ventilated in an intensive care unit (ICU). Co-primary endpoints were the length of ICU stay (days) and time to extubation (hours). Secondary endpoint was mortality rate at the longest follow-up available.</p><p>Results</p><p>The 27 included manuscripts (28 trials) randomized 3,648 patients (1,870 to dexmedetomidine and 1,778 to control). Overall analysis showed that the use of dexmedetomidine was associated with a significant reduction in length of ICU stay (weighted mean difference (WMD) = −0.79 [−1.17 to −0.40] days, p for effect <0.001) and of time to extubation (WMD = −2.74 [−3.80 to −1.65] hours, p for effect <0.001). Mortality was not different between dexmedetomidine and controls (risk ratio = 1.00 [0.84 to 1.21], p for effect = 0.9). High heterogeneity between included studies was found.</p><p>Conclusions</p><p>This meta-analysis of randomized controlled studies suggests that dexmedetomidine could help to reduce ICU stay and time to extubation, in critically ill patients even if high heterogeneity between studies might confound the interpretation of these results.</p></div

Doses, sedation scales and target sedation levels.

<p>ICU: Intensive Care Unit; CPB: cardiopulmonary bypass; NA: not available.</p

Description of the 28 trials included in the meta-analysis.

<p>Dex: dexmedetomidine; ICU: Intensive Care Unit; NA: not available; RASS: Richmond Agitation Sedation Scale; BIS: BispectralIndex ; MAAS: Motor Activity Assessment Scale.</p

Secondary Outcomes.

<p>Dex: dexmedetomidine; RR: relative risk; CI: confidence interval; P: p-value.</p

Forest plot for the time to extubation.

<p>Overall analysis showed that the use of dexmedetomidine was associated with a significant reduction of time to extubation (SMD = −0.39 [−0.66 to −0.11], p for effect = 0.005, p for heterogeneity <0.001, I2 = 93% with 24 studies and 3,478 patients included). CI = confidence interval; SMD = standardized mean difference; N = number; SD = standard deviation; Dex = dexmedetomidine.</p

Additive Effect on Survival of Anaesthetic Cardiac Protection and Remote Ischemic Preconditioning in Cardiac Surgery: A Bayesian Network Meta-Analysis of Randomized Trials

<div><p>Introduction</p><p>Cardioprotective properties of volatile agents and of remote ischemic preconditioning have survival effects in patients undergoing cardiac surgery. We performed a Bayesian network meta-analysis to confirm the beneficial effects of these strategies on survival in cardiac surgery, to evaluate which is the best strategy and if these strategies have additive or competitive effects.</p><p>Methods</p><p>Pertinent studies were independently searched in BioMedCentral, MEDLINE/PubMed, Embase, and the Cochrane Central Register (updated November 2013). A Bayesian network meta-analysis was performed. Four groups of patients were compared: total intravenous anesthesia (with or without remote ischemic preconditioning) and an anesthesia plan including volatile agents (with or without remote ischemic preconditioning). Mortality was the main investigated outcome.</p><p>Results</p><p>We identified 55 randomized trials published between 1991 and 2013 and including 6,921 patients undergoing cardiac surgery. The use of volatile agents (posterior mean of odds ratio = 0.50, 95% CrI 0.28–0.91) and the combination of volatile agents with remote preconditioning (posterior mean of odds ratio = 0.15, 95% CrI 0.04–0.55) were associated with a reduction in mortality when compared to total intravenous anesthesia. Posterior distribution of the probability of each treatment to be the best one, showed that the association of volatile anesthetic and remote ischemic preconditioning is the best treatment to improve short- and long-term survival after cardiac surgery, suggesting an additive effect of these two strategies.</p><p>Conclusions</p><p>In patients undergoing cardiac surgery, the use of volatile anesthetics and the combination of volatile agents with remote preconditioning reduce mortality when compared to TIVA and have additive effects. It is necessary to confirm these results with large, multicenter, randomized, double-blinded trials comparing these different strategies in cardiac and non-cardiac surgery, to establish which volatile agent is more protective than the others and how to best apply remote ischemic preconditioning.</p></div

Posterior distribution of mean and 95% credible interval, for the anesthetic agent difference effects, derived by Bayesian hierarchical model.

<p>* Indirect treatment difference effect calculated from consistency equation.</p><p>^sign Significant treatment difference effect.</p><p>TIVA (Total intravenous anesthesia) is the reference treatment.</p><p>TIVA: Total intravenous anesthesia</p><p>Posterior distribution of mean and 95% credible interval, for the anesthetic agent difference effects, derived by Bayesian hierarchical model.</p