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Effect of Dexmedetomidine on Lactate Clearance in Patients With Septic Shock

A Subanalysis of a Multicenter Randomized Controlled Trial

Miyamoto, Kyohei*; Nakashima, Tsuyoshi*; Shima, Nozomu*; Kato, Seiya*; Ueda, Kentaro*; Kawazoe, Yu; Ohta, Yoshinori; Morimoto, Takeshi§; Yamamura, Hitoshi on behalf of DESIRE Trial Investigators

doi: 10.1097/SHK.0000000000001055
Clinical Science Aspects
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ABSTRACT Lactate clearance is useful to guide initial resuscitation of patients with septic shock. We conducted this study to evaluate whether dexmedetomidine increases lactate clearance in patients with septic shock. This was a randomized controlled trial that involved a post hoc subgroup analysis. Adult patients with septic shock under ventilation were randomized to receive sedation strategy with or without dexmedetomidine (60 in the dexmedetomidine and 51 in the nondexmedetomidine groups). The primary outcome was the lactate clearance at 6 h, defined as the percent decrease in lactate from randomization to 6 h after. The median Acute Physiology and Chronic Health Evaluation II score was 25 (interquartile range 19–31). The median serum lactate value at randomization was lower in the dexmedetomidine group than in the nondexmedetomidine group (4.0 mmol/L vs. 4.8 mmol/L; P = 0.053). The lactate clearance at 6 h was higher in the dexmedetomidine group, although this was not statistically significant (23.3 ± 29.8 vs. 11.1 ± 54.4, mean difference 12.2, 95% confidence interval (CI), –4.4 to 28.8). After adjusting for the lactate level at randomization, lactate clearance at 6 h was significantly higher in the dexmedetomidine group (adjusted mean difference 18.5, 95% CI, 2.2–34.9). There was no statistically significant difference in the 28-day mortality between the dexmedetomidine and the nondexmedetomidine groups (13 [22%] vs. 18 [35%] patients, P = 0.11). In conclusion, among mechanically ventilated patients with septic shock, sedation with dexmedetomidine resulted in increased lactate clearance compared with sedation without dexmedetomidine.

*Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Japan

Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan

§Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan

Department of Disaster and Critical Care Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

Address reprint requests to Kyohei Miyamoto, MD, Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Wakayama, Japan. E-mail: go.go.kyohei.miyamoto@gmail.com

Received 6 September, 2017

Revised 27 September, 2017

Accepted 1 November, 2017

Our study was presented in part at the 30th Annual Congress of European Society of Intensive Care Medicine, Vienna, Austria, in September 2017.

Ethics approval and consent to participate: The study was conducted in Wakayama Medical University, Osaka City University, Osaka City General Hospital, Hyogo College of Medicine, Saga University Hospital, National Hospital Organization Kyoto Medical Center, Sapporo Medical University, and Yamaguchi Grand Medical Center, and was approved by the Institutional Review Boards of each hospital. The written informed consent was obtained.

Availability of data and materials: The datasets generated and analyzed during the current study are not publicly available due privacy concerns and institutional policy.

Authors’ contributions: KM, TN, and NS conceived the study idea and designed the study. KM, YK, YO, TM, and HY provided methodological and statistical advice on study design and data analysis. KU and SK helped to draft this manuscript, and revised it. All authors read and approved the final manuscript.

The original study was supported in part by a noncontractual research grant to Wakayama Medical University provided by Hospira Japan. The present subanalysis was conducted sorely by the academic investigators without any support from pharmaceutical companies.

The authors report no conflicts of interest.

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© 2018 by the Shock Society