Email this article 
Post a Comment The effectiveness of dexmedetomidine in patients with severe COVID-19
- Authors: Andreychenko S.A.1,2, Bychinin M.V.2, Mandel I.A.2,3, Klypa T.V.2
-
Affiliations:
- Central Clinical Hospital “RZD-Medicine”
- Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
- Issue: Vol 12, No 4 (2021)
- Pages: 5-11
- Section: Original Study Articles
- URL: https://journals.rcsi.science/clinpractice/article/view/88180
- DOI: https://doi.org/10.17816/clinpract88180
- ID: 88180
Cite item
Full Text
Abstract
Background: Mortality in patients with severe COVID-19 remains high. Finding therapies that can improve the outcome in these patients is an urgent task.
Aims: To evaluate the clinical efficacy of dexmedetomidine in the complex treatment of patients with a severe course of COVID-19.
Methods: The retrospective study included 50 adult patients with severe COVID-19 admitted to the intensive care unit (ICU). The primary outcome of the study was the incidence of delirium. The secondary results of the study were the dynamics of gas exchange indicators (PaO2 and PaCO2) and inflammatory markers (C-reactive protein, CRP; procalcitonin, lymphocyte count, and neutrophil-lymphocyte ratio, NLR) on day 3 and day 5 of the treatment, as well as the duration of mechanical ventilation (MV), length of stay (LOS) in the ICU and in the hospital and mortality.
Results: The incidence of delirium did not differ between the dexmedetomidine group and the control group (41 and 48%, respectively; p=0.661). The LOS in the ICU and in the hospital, as well as the MV duration, was comparable between the groups. However, the hospital mortality in the dexmedetomidine treatment group was lower than that in the control group (10.3% and 42.9%, respectively; p=0.008). The addition of dexmedetomidine to the therapy complex did not affect the blood gas composition but contributed to the increase in the number of lymphocytes (p=0.006) and to the NLS decrease (p=0.002) by the fifth day of treatment. At the same time, no significant changes in the CRP and procalcitonin levels were observed.
Conclusion: In the treatment group, the mortality was statistically significantly lower than it was in the control group. At the same time, the use of dexmedetomidine did not reduce the incidence of delirium, the length of stay in the ICU and in the hospital, and the duration of mechanical ventilation in patients with severe COVID-19. The revealed relationship between the use of dexmedetomidine and NLR and the number of lymphocytes suggests an immune-mediated effect on the outcome in this category of patients. Prospective randomized trials are needed to confirm the beneficial effects of dexmedetomidine on the immune system and mortality.
Keywords
Full Text
##article.viewOnOriginalSite##About the authors
Sergey A. Andreychenko
Central Clinical Hospital “RZD-Medicine”; Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Author for correspondence.
Email: sergandletter@gmail.com
ORCID iD: 0000-0002-3180-3805
SPIN-code: 3186-2493
Scopus Author ID: 716831
Russian Federation, Moscow; 28, Orechovy boulevard, Moscow, 115682
Mikhail V. Bychinin
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: drbychinin@gmail.com
ORCID iD: 0000-0001-8461-4867
SPIN-code: 6524-9947
M.D., Ph.D.
Russian Federation, 28, Orechovy boulevard, Moscow, 115682Irina A. Mandel
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency; I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: irina.a.mandel@gmail.com
ORCID iD: 0000-0001-9437-6591
SPIN-code: 7778-2184
M.D., Ph.D.
Russian Federation, 28, Orechovy boulevard, Moscow, 115682; MoscowTatiana V. Klypa
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: tvklypa@gmail.com
ORCID iD: 0000-0002-2732-967X
SPIN-code: 2349-8980
M.D., Ph.D., Dr. Sci. (Med.)
Russian Federation, 28, Orechovy boulevard, Moscow, 115682References
- Carley S, Horner D, Body R, Mackway-Jones K. Evidence-based medicine and COVID-19: what to believe and when to change. Emergency Med J. 2020;37(9):572–575. doi: 10.1136/emermed-2020-210098
- Pasin L, Landoni G, Nardelli P, et al. Dexmedetomidine reduces the risk of delirium, agitation and confusion in critically Ill patients: a meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth. 2014;28(6):1459–1466. doi: 10.1053/j.jvca.2014.03.010
- Stockton J, Kyle-Sidell C. Dexmedetomidine and worsening hypoxemia in the setting of COVID-19: a case report. Am J Emerg Med. 2020;38(10):2247.e1–2247.e2. doi: 10.1016/j.ajem.2020.05.066
- Zhao H, Davies R, Ma D. Potential therapeutic value of dexmedetomidine in COVID-19 patients admitted to ICU. Br J Anaesth. 2021;126(1):e33–e35. doi: 10.1016/j.bja.2020.09.031
- Liu J, Shi K, Hong J, et al. Dexmedetomidine protects against acute kidney injury in patients with septic shock. Ann Palliat Med. 2020;9(2):224–230. doi: 10.21037/apm.2020.02.08
- Castillo RL, Ibacache M, Cortínez I, et al. Dexmedetomidine improves cardiovascular and ventilatory outcomes in critically ill patients: basic and clinical approaches. Front Pharmacol. 2020;10:1641. doi: 10.3389/fphar.2019.01641
- Klypa TV, Bychinin MV, Mandel IA, et al. Clinical characteristics of patients admitted to an ICU with COVID-19. Predictors of the severe disease. Journal of Clinical Practice. 2020; 11(2):6–20. doi: 10.17816/clinpract34182
- Izcovich A, Ragusa MA, Tortosa F, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: a systematic review. PLoS One. 2020;15(11):e0241955. doi: 10.1371/journal.pone.0241955
- The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. JAMA. 2020;324(13):1330–1341. doi: 10.1001/jama.2020.17023
- Flükiger J, Hollinger A, Speich B, et al. Dexmedetomidine in prevention and treatment of postoperative and intensive care unit delirium: a systematic review and meta-analysis. Ann Intensive Care. 2018;8(1):92. doi: 10.1186/s13613-018-0437-z
- Arumugam S, El-Menyar A, Al-Hassani A, et al. Delirium in the intensive care unit. J Emerg Trauma Shock. 2017;10(1):37–46. doi: 10.4103/0974-2700.199520
- Hughes CG, Mailloux PT, Devlin JW, et al. Dexmedetomidine or propofol for sedation in mechanically ventilated adults with sepsis. N Engl J Med. 2021;384(15):1424–1436. doi: 10.1056/NEJMoa2024922
- Bao N, Tang B. Organ-protective effects and the underlying mechanism of dexmedetomidine. Mediators Inflamm. 2020;2020: 6136105. doi: 10.1155/2020/6136105
- Cai J, Li H, Zhang C, et al. The neutrophil-to-lymphocyte ratio determines clinical efficacy of corticosteroid therapy in patients with COVID-19. Cell Metab. 2021;33(2):258–269.e3. doi: 10.1016/j.cmet.2021.01.002
- Magoon R. Dexmedetomidine in COVID-19: probing promises with prudence! Am J Emerg Med. 2020;46:708–709. doi: 10.1016/j.ajem.2020.10.034
Supplementary files
