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

Su-Qin Huang, Jian Zhang, Xiong-Xin Zhang, Lu Liu, Yang Yu, Xian-Hui Kang, Xiao-Min Wu, Sheng-Mei Zhu, Su-Qin Huang, Jian Zhang, Xiong-Xin Zhang, Lu Liu, Yang Yu, Xian-Hui Kang, Xiao-Min Wu, Sheng-Mei Zhu

Abstract

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.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Methodological quality assessment.
Figure 2
Figure 2
Complete search strategy.
Figure 3
Figure 3
Meta-analysis of intraoperative oxygenation index. (a) Forest plot for intraoperative oxygenation index: dexmedetomidine vs. placebo. (b) Funnel plot of 7 reviewed studies on intraoperative oxygenation index when comparing dexmedetomidine with placebo.
Figure 4
Figure 4
Subgroup analysis of intraoperative oxygenation index.
Figure 5
Figure 5
Meta-analysis of intrapulmonary shunt.
Figure 6
Figure 6
Meta-analysis of intraoperative heart rate and mean arterial pressure. (a) Forest plot for heart rate: dexmedetomidine vs. placebo. (b) Forest plot for mean arterial pressure: dexmedetomidine vs. placebo.
Figure 7
Figure 7
Sensitivity analyses of the intraoperative oxygenation index (a), intrapulmonary shunt (b), heart rate (c), and mean arterial pressure (d).

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Source: PubMed

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