AUTHOR=Li Lulan , Shi Xiaotong , Xiong Ming , Kong Karen , Chen Zhongqing , Zhou Shiyu , Zeng Zhenhua , An Shengli , Xu Bo 

TITLE=Dexmedetomidine only regimen for long-term sedation is associated with reduced vasopressor requirements in septic shock patients: A retrospective cohort study from MIMIC-IV database

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1107251

DOI=10.3389/fmed.2023.1107251

ISSN=2296-858X

ABSTRACT=Background
Previous studies have shown that dexmedetomidine (DEX) may be associated with reduced vasopressor requirements in septic shock patients, however, long-term DEX-only sedation in reducing vasopressor requirements is still controversial.
Methods
A retrospective study was conducted among patients with septic shock on mechanical ventilation using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The primary outcome was the ratio of norepinephrine equivalent dose to mean arterial pressure (NEq/MAP) in the first 72 h after DEX or other sedatives for sedation. The secondary outcomes were key organ function parameters, 28-day mortality, and 90-day mortality. Univariate, propensity score matching (PSM), and generalized linear mixed model (GLMM) analyses were performed.
Results
DEX was associated with decreased NEq/MAP in the first 72 h (difference=0.05, 95% CI=-0.02-0.08, p=0.002) after adjusting for confounders in the GLMM analysis. The DEX group was also associated with a lower heart rate, cardiac output (CO), lactate level, aspartate transaminase (AST) level, and higher PaO2/FiO2 ratio (p<0.0125). Moreover, DEX only sedation was associated with reduced 90-day mortality (OR=0.60, 95% CI=0.37-0.94, p=0.030). 
Conclusion
DEX may be associated with decreased vasopressor requirements, improved AST and PaO2/FiO2 levels, and reduced 90-day mortality in patients with septic shock, which warrants further study.