Dexmedetomidine versus Propofol Sedation for Prevention of Postoperative Delirium: Clarifications Required [Letter]
Bibliographic record
Abstract
We read with great interest the randomized controlled trial (RCT) published by Shi et al 1 which investigated the efficacy of dexmedetomidine in reducing the incidence and duration of postoperative delirium in older adults following cardiac surgery.While the results provided valuable insights, several clarifications are required in regards to the trial's methodology and conduct.Firstly, the authors claimed that their RCT was registered in the Chinese Clinical Trial Registry (ChiCTR No. ChiCTR-IOR-17014122).However, the clinical trial associated with this registration number compared the efficacy of dexmedetomidine as an adjuvant therapy to ropivacaine in patients undergoing laparoscopic colon operations, 2 which is drastically different from the published RCT.Furthermore, we were unable to identify any registration associated with this trial following searches on ChiCTR using the authors' affiliations.Prospective registration of clinical trials is crucial for ensuring scientific transparency and integrity, and is an essential component of the CONSORT statement.3 Therefore, it is concerning that the authors reported an invalid registration number as it is unknown whether this RCT was prospectively registered.Moreover, it is unclear whether dexmedetomidine was used as an adjunctive therapy to propofol or a monotherapy.In the Results section, the authors referred to the experimental and control groups as "DEX" and "PRO", respectively.This implies that the RCT compared dexmedetomidine monotherapy against propofol monotherapy.However, the authors also claimed that both groups received propofol for general anesthesia and postoperative sedation in their methodology, which conflicts with the implications of the groups' naming schemes.Additionally, the authors did not clarify whether the dexmedetomidine regimen was continued upon ICU admission and only commented on the propofol regimens.The authors' discussion further complicated this as they concluded that dexmedetomidine might be both an "attractive adjuvant," as well as an "alternative" to propofol.This could suggest that their trial involved both dexmedetomidine adjuvants and monotherapy.We could not verify the exact intervention arms involved in this trial, as a valid trial registration number was not provided.This unclear reporting may lead to errors in future reviews and treatment guidelines.For instance, this RCT was included in a recent meta-analysis by Abowali et al which investigated the efficacy of dexmedetomidine compared to
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.095 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.004 | 0.005 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.061 | 0.044 |
| Insufficient payload (model declined to judge) | 0.007 | 0.009 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".