Background
Methods
Search strategy and study criteria
Literature review and data extraction
Postoperative outcomes
Statistical analysis
Results
Study characteristics
Study | Country | Surgery | Dexmedetomidine Dose | Control | Time and Duration of intervention or Control | No. of Patients | Clinical End Point | AKI Definition | Follow-Up |
---|---|---|---|---|---|---|---|---|---|
Balkanay2015 I [17] | Turkey | On-PUMP CABG | 0.04μg/kg/h-0.05μg/kg/h | placebo | Start preCPB and last for 24 h | 31 vs 28 | AKI;MV duration; ICU stay; Hospital stay | RIFLE | In hospital |
Balkanay2015II [17] | Turkey | On-PUMP CABG | 0.04μg/kg/h-0.05μg/kg/h | placebo | Start preCPB and last for 24 h | 29 vs 28 | AKI;MV duration; ICU stay; Hospital stay | RIFLE | In hospital |
Cho 2015 [12] | Korea | Combined | 0.04μg/kg/h | placebo | Start immediately after anesthetic induction and last for 24 h | 100 vs100 | AKI; Mortality; ICU stay; | AKIN | In hospital |
DjaianiG 2016 [18] | Canada | Combined | 0.4μg/kg 0.2–0.7μg/kg/h | propofol | Start postsurgery and last for 24 h | 91 vs 92 | AKI; Mortality; MV duration; ICU stay; Hospital stay | NA | In hospital |
Leino 2011 [19] | Finland | On-PUMP CABG | 0.6 ng/ml | placebo | Start immediately after anesthetic induction and last for 4 h arrive ICU | 35 VS 31 | AKI; MV duration; | RIFLE | In hospital |
Li 2017 [14] | China | Combined | 0.1μg/kg/h-0.6μg/kg/h | placebo | Start preCPB and last until the end of MV | 142 vs143 | AKI;MV duration; ICU stay | KDIGO | 30 days after surgery |
Liu 2016 [20] | China | Combined | <1.5μg/kg/h | propofol | Start after surgery and last until the end of MV | 44 vs 44 | AKI; Mortality; MV duration; ICU stay; Hospital stay | AKIN | In hospital |
Park 2014 [13] | Korea | Combined | 0.5μg/kg 0.2–0.8μg/kg/h | remifentanil | Start after surgery and last until extubation | 67 vs 75 | AKI; MV duration; ICU stay; Hospital stay | Cr > 100%abovebaseline or new dialysis need | In hospital |
Shehabi2009 [21] | Australia | Combined | 0.1–0.7μg/kg/ml | morphine | Start within 1 h of adminssin to CICU until the removal of chest drains | 152 vs147 | AKI; Mortality; MV duration; ICU stay; Hospital stay | NA | 12 days after surgery |
Ammar 2016 [22] | Egypt | Combined | 1 μg/kg over 15 min, followed by 0.5 μg/kg/h | placebo | Start preCPB and last until 6 h after surgery | 25 vs 25 | AKI; Mortality; MV duration; ICU stay; Hospital stay | NA | 30 days after surgery |
Soliman 2016 [23] | Egypt | Aortic vascular surgery | 1 μg/kg 0.3 μg/kg/h | placebo | Start 15 min before induction maintained to the end of surgery | 75 vs 75 | AKI; Mortality; | Cr > 115 μmol/L | In hospital |
Study | Age | Male (%) | DM (%) | HP (%) | PreMI (%) | LVEF (%) | CPB duration (min) | Anesthetics | Baseline Serum Creatinine | β-blocker (%) | Statins (%) |
---|---|---|---|---|---|---|---|---|---|---|---|
Balkanay 2015 I [17] | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
Balkanay 2015II [17] | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
Cho 2015 [12] | 63 | 48 | 19.5 | 45.5 | NA | 61.5 | 131 | Sevoflurane | 33 | NA | 63 |
DjaianiG 2016 [18] | 72.55 | 75.4 | 21.9 | 75.4 | 16.4 | NA | 98.99 | Isoflurane | 53 | 68.85 | 72.55 |
Leino 2011 [19] | 60.86 | 89.4 | NA | NA | NA | NA | NA | Isoflurane | NA | NA | 60.86 |
Li 2017 [14] | 67.18 | 69.1 | 32.3 | 63.2 | 9.8 | NA | 102.99 | Sevoflurane | 69.73 | 48.42 | 67.18 |
Liu 2016 [20] | 54.75 | 39.8 | 12.5 | 29.5 | NA | 65 | 71.15 | Sevoflurane | NA | NA | 54.75 |
Park 2014 [13] | 53.81 | 55.6 | 9.15 | 27.5 | NA | 61.87 | 166.75 | Sevoflurane | NA | NA | 53.81 |
Shehabi2009 [21] | 71.25 | 75.3 | 29.5 | 80.1 | 36.6 | NA | 98.98 | Sevoflurane | NA | NA | 71.25 |
Ammar 2016 [22] | 57.25 | 76 | 68 | 82 | NA | NA | 66.2 | Isoflurane | 94 | 56 | 57.25 |
Soliman 2016 [23] | 58.1 | 50 | 30.7 | 48.7 | 8.6 | 52.9 | NA | NA | 36.67 | NA | 58.1 |
Study | Random sequence generation | Allocation Concealment | Blinding of participants and personnel | Blinding of outcome assessment | Attrition bias | Selective reporting | Jadad scale |
---|---|---|---|---|---|---|---|
Balkanay 2015 I [17] | Yes | Unclear | Yes | Yes | Unclear | Unclear | 4 |
Balkanay 2015 II [17] | Yes | Unclear | Yes | Yes | Unclear | Unclear | 4 |
Cho 2015 [12] | Yes | Sealed envelopes | Blinding of personnel | Yes | Unclear | Unclear | 4 |
Djaiani G 2016 [18] | Yes | Sealed envelopes | Blinding of personnel | No | Yes | Unclear | 3 |
Leino 2011 [19] | Yes | Sealed envelopes | No | Yes | Yes | Unclear | 5 |
Li 2017 [14] | Yes | Sealed envelopes | Yes | No | Yes | Unclear | 5 |
Liu 2016 [20] | Yes | Unclear | Unclear | Unclear | Unclear | Unclear personnel | 1 |
Park 2014 [13] | Yes | Unclear | Unclear | Unclear | Unclear | Unclear | 1 |
Shehabi 2009 [21] 2009 | Yes | Unclear | Yes | No | Yes | Unclear | 5 |
Ammar 2016 [22] | Yes | Unclear | Yes | Yes | Unclear | Unclear | 4 |
Soliman 2016 [23] | Yes | Unclear | Yes | No | Unclear | Unclear | 4 |
Effect of Dexmedetomidine on incidence of AKI, and mortality
Analysis method | OR | 95%CI | I2 |
P
| RD | 95%CI | I2 |
P
| RR | 95%CI | I2 |
P
|
---|---|---|---|---|---|---|---|---|---|---|---|---|
Mantel-Haenszel | 0.65 | 0.45,0.92 | 0% | 0.02 | −0.02 | −0.04,0.01 | 46% | 0.28 | 0.72 | 0.54,0.95 | 0% | 0.02 |
Inverse Variance | 0.65 | 0.45,0.92 | 0% | 0.02 | −0.01 | −0.04,0.01 | 21% | 0.22 | 0.72 | 0.54,0.95 | 0% | 0.02 |
Subgroup | Endpoint | No. of Comparisons | OR WMD | 95% CI | P Value | I2 | PDifference Value |
---|---|---|---|---|---|---|---|
1. Age(years) | AKI | 9 | 0.64 | 0.41~ 1.01 | 0.06 | 43.8% | 0.18 |
≥ 60 | 5 | 0.54 | 0.31~ 0.94 | 0.03 | 32% | ||
< 60 | 4 | 1.12 | 0.45~ 2.79 | 0.81 | 0% | ||
2. Gender(Male%) | AKI | 9 | 0.64 | 0.41~ 1.01 | 0.06 | 0% | 0.91 |
≥ 60 | 4 | 0.70 | 0.28~ 1.74 | 0.45 | 47% | ||
< 60 | 5 | 0.75 | 0.46~ 1.20 | 0.22 | 0.0% | ||
3. Previous DM (%) | AKI | 8 | 0.64 | 0.41 ~ 1.01 | 0.22 | 0% | 0.86 |
≥ 25 | 4 | 0.75 | 0.48 ~ 1.18 | 0.22 | 0% | ||
< 25 | 4 | 0.68 | 0.21 ~ 2.14 | 0.51 | 49% | ||
4.CPB duration(minutes) | AKI | 7 | 0.65 | 0.38 ~ 1.14 | 0.13 | 0% | 0.59 |
≥ 100 | 3 | 0.61 | 0.27 ~ 1.36 | 0.22 | 60% | ||
< 100 | 4 | 0.85 | 0.34 ~ 2.15 | 0.73 | 0% | ||
5.Statin (%) | AKI | 9 | 0.64 | 0.41 ~ 1.01 | 0.06 | 43.8% | 0.18 |
≥ 60 | 5 | 0.54 | 0.31~ 0.94 | 0.03 | 32% | ||
< 60 | 4 | 1.12 | 0.45 ~ 2.79 | 0.81 | 0% | ||
6.Loading dose use | AKI | 10 | 0.65 | 0.45 ~ 0.92 | 0.02 | 0% | 0.86 |
Yes | 4 | 0.72 | 0.24 ~ 2.10 | 0.54 | 0% | ||
No | 6 | 0.64 | 0.40 ~ 1.02 | 0.06 | 16% | ||
7. Continuous infusion | AKI | 9 | 0.61 | 0.42 ~ 0.88 | 0.008 | 68.3% | 0.08 |
≥ 0.1 μg/kg/h | 6 | 0.76 | 0.49~ 1.18 | 0.22 | 0% | ||
< 0.1 μg/kg/h | 3 | 0.37 | 0.19 ~ 0.72 | 0.003 | 0% | ||
8. Control drugs | AKI | 11 | 0.65 | 0.45 ~ 0.92 | 0.02 | 0% | 0.33 |
Placebo | 7 | 0.60 | 0.40 ~ 0.89 | 0.01 | 2% | ||
Others | 4 | 0.96 | 0.40 ~ 2.29 | 0.93 | 0% | ||
9. Dex administration | AKI | 11 | 0.65 | 0.45 ~ 0.92 | 0.02 | 0% | 0.21 |
Pre/Intraoperation | 8 | 0.59 | 0.40 ~ 0.87 | 0.007 | 0% | ||
Postoperation | 3 | 1.11 | 0.45 ~ 2.74 | 0.83 | 0% | ||
10. Surgical procedures | AKI | 11 | 0.65 | 0.45 ~ 0.92 | 0.02 | 0% | 0.87 |
CABG or Aortic surgery | 4 | 0.72 | 0.24 ~ 2.16 | 0.56 | 0% | ||
Combined | 7 | 0.65 | 0.38 ~ 1.14 | 0.13 | 33% | ||
11. JADAD score | AKI | 11 | 0.65 | 0.45 ~ 0.92 | 0.02 | 65.7% | 0.09 |
≥ 3 | 9 | 0.59 | 0.41 ~ 0.86 | 0.006 | 0% | ||
< 3 | 2 | 1.88 | 0.53 ~ 6.73 | 0.33 | 0% |