Dexmedetomidine for Reducing Mortality in Patients with Septic Shock: A Randomized Controlled Trial (DecatSepsis)
Abstract
BACKGROUND
Sepsis, especially septic shock, and its complications have been linked to the hyperadrenergic stress response.
RESEARCH QUESTION
Does decatecholaminization with dexmedetomidine (DEX) lower the in-hospital mortality in septic shock patients?
STUDY DESIGN AND METHODS
This open-label randomized controlled trial assessed the effects of a heart rate (HR)-calibrated DEX infusion on in-hospital mortality in patients with septic shock and HR >90 beats per minute (bpm), whether they are mechanically ventilated or not. DEX was infused for 48 hours to maintain the HR at 60-90 bpm. Mechanically ventilated patients received conventional sedation in both groups. Other outcomes were the norepinephrine (NE) equivalent dose, the need for additional vasopressor, APACHE-II score, persistent atrial fibrillation (AF), and C-reactive protein (CRP).
RESULTS
In 90 patients of either sex, DEX reduced the mean HR over the first three days in the ICU by 11.2 bpm (95% CI -17 to -5) (P < 0.001). The in-hospital mortality risk ratio (RR) was 0.68, 95% CI 0.43 to 1.07, P = 0.091. The DEX group received an NE equivalent dose of 0.55 (0.37-0.82) mcg/kg/min vs. 0.61 (0.47-0.89) (P = 0.121). DEX reduced the epinephrine infusion rescue: relative risk reduction = 0.6 (95% CI 0.06 to 0.93), P = 0.025. The RR of persistent AF was 0.47; 95% CI 0.21 to 0.99; P = 0.05. DEX reduced the median APACHE-II score on the third day by -6; 95% CI -10 to -2; P =0.003; and the mean CRP concentration by -40 mg/dl…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 90 participants or records.
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