Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials
Background: One-lung ventilation (OLV) is a common ventilation technology during thoracic surgery that can cause serious clinical problems. We aimed to conduct a meta-analysis to compare oxygenation and intrapulmonary shunt during OLV in adults undergoing thoracic surgery with dexmedetomidine (Dex)...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2017-01-01
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| Series: | Chinese Medical Journal |
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| Online Access: | http://www.cmj.org/article.asp?issn=0366-6999;year=2017;volume=130;issue=14;spage=1707;epage=1714;aulast=Huang |
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| author | Su-Qin Huang Jian Zhang Xiong-Xin Zhang Lu Liu Yang Yu Xian-Hui Kang Xiao-Min Wu Sheng-Mei Zhu |
| author_facet | Su-Qin Huang Jian Zhang Xiong-Xin Zhang Lu Liu Yang Yu Xian-Hui Kang Xiao-Min Wu Sheng-Mei Zhu |
| author_sort | Su-Qin Huang |
| collection | DOAJ |
| description | Background: One-lung ventilation (OLV) is a common ventilation technology during thoracic surgery that can cause serious clinical problems. We aimed to conduct a meta-analysis to compare oxygenation and intrapulmonary shunt during OLV in adults undergoing thoracic surgery with dexmedetomidine (Dex) versus placebo to assess the influence and safety of using Dex.
Methods: Randomized controlled trials comparing lung protection in patients who underwent thoracic surgery with Dex or a placebo were retrieved from PubMed, EMBASE, MEDLINE, Cochrane Library, and China CNKI database. The following information was extracted from the paper: arterial oxygen partial pressure (PaO2), PaO2/inspired oxygen concentration (PaO2/FiO2, oxygenation index [OI]), intrapulmonary shunt (calculated as Qs/Qt), mean arterial pressure (MAP), heart rate (HR), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, superoxide dismutase (SOD), and malondialdehyde (MDA).
Results: Fourteen randomized controlled trials were included containing a total of 625 patients. Compared with placebo group, Dex significantly increased PaO2/FiO2(standard mean difference [SMD] = 0.98, 95% confidence interval [CI] [0.72, 1.23], P < 0.00001). Besides, Qs/Qt (SMD= −1.22, 95% CI [−2.20, −0.23], P = 0.020), HR (SMD= −0.69, 95% CI [−1.20, 0.17], P = 0.009), MAP (SMD= −0.44, 95% CI [−0.84, 0.04], P = 0.030), the concentrations of TNF-α (SMD = −1.55, 95% CI [−2.16, −0.95], P <0.001), and IL-6 (SMD = −1.53, 95% CI [−2.37, −0.70], P = 0.0003) were decreased in the treated group, when compared to placebo group. No significant difference was found in MDA (SMD = −1.14, 95% CI [−3.48, 1.20], P = 0.340) and SOD (SMD = 0.41, 95% CI [−0.29, 1.10], P = 0.250) between the Dex group and the placebo group. Funnel plots did not detect any significant publication bias.
Conclusions: Dex may improve OI and reduce intrapulmonary shunt during OLV in adults undergoing thoracic surgery. However, this conclusion might be weakened by the limited number of pooled studies and patients. |
| first_indexed | 2024-12-11T20:16:42Z |
| format | Article |
| id | doaj.art-e295657e52e34bd48b8bf2b7997001ac |
| institution | Directory Open Access Journal |
| issn | 0366-6999 |
| language | English |
| last_indexed | 2024-12-11T20:16:42Z |
| publishDate | 2017-01-01 |
| publisher | Wolters Kluwer |
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| series | Chinese Medical Journal |
| spelling | doaj.art-e295657e52e34bd48b8bf2b7997001ac2022-12-22T00:52:10ZengWolters KluwerChinese Medical Journal0366-69992017-01-01130141707171410.4103/0366-6999.209891Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled TrialsSu-Qin HuangJian ZhangXiong-Xin ZhangLu LiuYang YuXian-Hui KangXiao-Min WuSheng-Mei ZhuBackground: One-lung ventilation (OLV) is a common ventilation technology during thoracic surgery that can cause serious clinical problems. We aimed to conduct a meta-analysis to compare oxygenation and intrapulmonary shunt during OLV in adults undergoing thoracic surgery with dexmedetomidine (Dex) versus placebo to assess the influence and safety of using Dex. Methods: Randomized controlled trials comparing lung protection in patients who underwent thoracic surgery with Dex or a placebo were retrieved from PubMed, EMBASE, MEDLINE, Cochrane Library, and China CNKI database. The following information was extracted from the paper: arterial oxygen partial pressure (PaO2), PaO2/inspired oxygen concentration (PaO2/FiO2, oxygenation index [OI]), intrapulmonary shunt (calculated as Qs/Qt), mean arterial pressure (MAP), heart rate (HR), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, superoxide dismutase (SOD), and malondialdehyde (MDA). Results: Fourteen randomized controlled trials were included containing a total of 625 patients. Compared with placebo group, Dex significantly increased PaO2/FiO2(standard mean difference [SMD] = 0.98, 95% confidence interval [CI] [0.72, 1.23], P < 0.00001). Besides, Qs/Qt (SMD= −1.22, 95% CI [−2.20, −0.23], P = 0.020), HR (SMD= −0.69, 95% CI [−1.20, 0.17], P = 0.009), MAP (SMD= −0.44, 95% CI [−0.84, 0.04], P = 0.030), the concentrations of TNF-α (SMD = −1.55, 95% CI [−2.16, −0.95], P <0.001), and IL-6 (SMD = −1.53, 95% CI [−2.37, −0.70], P = 0.0003) were decreased in the treated group, when compared to placebo group. No significant difference was found in MDA (SMD = −1.14, 95% CI [−3.48, 1.20], P = 0.340) and SOD (SMD = 0.41, 95% CI [−0.29, 1.10], P = 0.250) between the Dex group and the placebo group. Funnel plots did not detect any significant publication bias. Conclusions: Dex may improve OI and reduce intrapulmonary shunt during OLV in adults undergoing thoracic surgery. However, this conclusion might be weakened by the limited number of pooled studies and patients.http://www.cmj.org/article.asp?issn=0366-6999;year=2017;volume=130;issue=14;spage=1707;epage=1714;aulast=HuangDexmedetomidine; Intrapulmonary Shunt; Meta-analysis; One-lung Ventilation; Oxygenation Index |
| spellingShingle | Su-Qin Huang Jian Zhang Xiong-Xin Zhang Lu Liu Yang Yu Xian-Hui Kang Xiao-Min Wu Sheng-Mei Zhu Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials Chinese Medical Journal Dexmedetomidine; Intrapulmonary Shunt; Meta-analysis; One-lung Ventilation; Oxygenation Index |
| title | Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials |
| title_full | Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials |
| title_fullStr | Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials |
| title_full_unstemmed | Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials |
| title_short | Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials |
| title_sort | can dexmedetomidine improve arterial oxygenation and intrapulmonary shunt during one lung ventilation in adults undergoing thoracic surgery a meta analysis of randomized placebo controlled trials |
| topic | Dexmedetomidine; Intrapulmonary Shunt; Meta-analysis; One-lung Ventilation; Oxygenation Index |
| url | http://www.cmj.org/article.asp?issn=0366-6999;year=2017;volume=130;issue=14;spage=1707;epage=1714;aulast=Huang |
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