Abstract
Background: Dexmedetomidine is an alpha 2-adrenergic receptor agonist. Apart from its sedative effects, dexmedetomidine has the potential to reduce mortality through its anti-inflammatory effect. However, the impact of dexmedetomidine on in-hospital outcomes of patients with severe burns remains unclear. Therefore, we aimed to elucidate the association between dexmedetomidine and mortality in mechanically-ventilated patients with severe burns, using a Japanese nationwide database of in-hospital patients.Methods: We included adults with severe burns (burn index ≥ 10) who were registered in the Japanese Diagnosis Procedure Combination national inpatient database from 2010 to 2018, started mechanical ventilation within 3 days of admission, and received any sedative drug (dexmedetomidine, midazolam, or propofol). One-to-one propensity score matching was performed between patients who received dexmedetomidine on the day of mechanical ventilation initiation (dexmedetomidine group) and those who did not receive dexmedetomidine (control group). The primary outcome was all-cause 30-day in-hospital mortality. Secondary outcomes were length of hospital stay and duration of mechanical ventilation in all patients and survivors.Results: Eligible patients (n = 1,888) were classified into the dexmedetomidine group (n = 371) or the control group (n = 1,517). After one-to-one propensity score matching, we compared 329 patients from each of the two groups. No significant difference was observed in 30-day mortality between patients in the dexmedetomidine and control groups (22.8% vs. 22.5%, respectively; odds ratio, 1.02; 95% confidence interval, 0.71-1.46). Moreover, there were no significant differences between patients in the dexmedetomidine and control groups in terms of the length of hospital stay or the duration of mechanical ventilation.Conclusions: We found no significant association between dexmedetomidine use and in-hospital outcomes (mortality, length of hospital stay, and length of mechanical ventilation) in mechanically-ventilated patients with severe burns. Dexmedetomidine use may not improve the above-mentioned outcomes; therefore, its selection should be based on the patient’s general condition and the target level of sedation.
Dexmedetomidine use and mortality in mechanically ventilated patients with severe burns: a cohort study using a national inpatient database in Japan
