Effects of dexmedetomidine on pulmonary function in patients receiving one-lung ventilation: a meta-analysis of randomized controlled trial

Lin Yang, Yongheng Cai, Lin Dan, He Huang, Bing Chen, Lin Yang, Yongheng Cai, Lin Dan, He Huang, Bing Chen

Abstract

Background: Mechanical ventilation, particularly one-lung ventilation (OLV), can cause pulmonary dysfunction. This meta-analysis assessed the effects of dexmedetomidine on the pulmonary function of patients receiving OLV.

Methods: The Embase, PubMed, MEDLINE, Cochrane Library, ClinicalTrials.gov, and Chinese Clinical Trial Registry databases were systematically searched. The primary outcome was oxygenation index (OI). Other outcomes including the incidence of postoperative complications were assessed.

Results: Fourteen randomized controlled trials involving 845 patients were included in this meta-analysis. Dexmedetomidine improved the OI at 30 (mean difference [MD]: 40.49, 95% CI [10.21, 70.78]), 60 (MD: 60.86, 95% CI [35.81, 85.92]), and 90 min (MD: 55, 95% CI [34.89, 75.11]) after OLV and after surgery (MD: 28.98, 95% CI [17.94, 40.0]) and improved lung compliance 90 min after OLV (MD: 3.62, 95% CI [1.7, 5.53]). Additionally, dexmedetomidine reduced the incidence of postoperative pulmonary complications (odds ratio: 0.44, 95% CI [0.24, 0.82]) and length of hospital stay (MD: -0.99, 95% CI [-1.25, -0.73]); decreased tumor necrosis factor-α, interleukin (IL)-6, IL-8, and malondialdehyde levels; and increased superoxide dismutase levels. However, only the results for the OI and IL-6 levels were confirmed by the sensitivity and trial sequential analyses.

Conclusions: Dexmedetomidine improves oxygenation in patients receiving OLV and may additionally decrease the incidence of postoperative pulmonary complications and shorten the length of hospital stay, which may be related to associated improvements in lung compliance, anti-inflammatory effects, and regulation of oxidative stress reactions. However, robust evidence is required to confirm these conclusions.

Keywords: Artificial respiration; Dexmedetomidine; Meta-analysis; One-lung ventilation; Postoperative complications; Respiratory mechanics..

Conflict of interest statement

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
“PRISMA” flow diagram.
Fig. 2.
Fig. 2.
Forest plot diagram showing the oxygenation index. SD: standard deviation, IV: inverse variance, OLV: one-lung ventilation.
Fig. 3.
Fig. 3.
Forest plot diagram showing lung compliance. SD: standard deviation, IV: inverse variance, OLV: one-lung ventilation.
Fig. 4.
Fig. 4.
Forest plot diagram showing postoperative pulmonary complications. IV: inverse variance, OLV: one-lung ventilation.
Fig. 5.
Fig. 5.
Forest plot diagram showing the length of hospital stay. SD: standard deviation, IV: inverse variance, OLV: one-lung ventilation.

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