Dexmedetomidine vs other sedatives in critically ill mechanically ventilated adults: a systematic review and meta-analysis of randomized trials

Kimberley Lewis, Fayez Alshamsi, Kallirroi Laiya Carayannopoulos, Anders Granholm, Joshua Piticaru, Zainab Al Duhailib, Dipayan Chaudhuri, Laura Spatafora, Yuhong Yuan, John Centofanti, Jessica Spence, Bram Rochwerg, Dan Perri, Dale M. Needham, Anne Holbrook, John W. Devlin, Osamu Nishida, Kimia Honarmand, Begüm Ergan, Eugenia KhorochkovPratik Pandharipande, Mohammed Alshahrani, Tim Karachi, Mark Soth, Yahya Shehabi, Morten Hylander Møller, Waleed Alhazzani, on behalf of the GUIDE group

Research output: Contribution to journalReview ArticleResearchpeer-review

40 Citations (Scopus)

Abstract

Conventional gabaminergic sedatives such as benzodiazepines and propofol are commonly used in mechanically ventilated patients in the intensive care unit (ICU). Dexmedetomidine is an alternative sedative that may achieve lighter sedation, reduce delirium, and provide analgesia. Our objective was to perform a comprehensive systematic review summarizing the large body of evidence, determining if dexmedetomidine reduces delirium compared to conventional sedatives. We searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov and the WHO ICTRP from inception to October 2021. Independent pairs of reviewers identified randomized clinical trials comparing dexmedetomidine to other sedatives for mechanically ventilated adults in the ICU. We conducted meta-analyses using random-effects models. The results were reported as relative risks (RRs) for binary outcomes and mean differences (MDs) for continuous outcomes, with corresponding 95% confidence intervals (CIs). In total, 77 randomized trials (n = 11,997) were included. Compared to other sedatives, dexmedetomidine reduced the risk of delirium (RR 0.67, 95% CI 0.55 to 0.81; moderate certainty), the duration of mechanical ventilation (MD − 1.8 h, 95% CI – 2.89 to – 0.71; low certainty), and ICU length of stay (MD – 0.32 days, 95% CI – 0.42 to – 0.22; low certainty). Dexmedetomidine use increased the risk of bradycardia (RR 2.39, 95% CI 1.82 to 3.13; moderate certainty) and hypotension (RR 1.32, 95% CI 1.07 to 1.63; low certainty). In mechanically ventilated adults, the use of dexmedetomidine compared to other sedatives, resulted in a lower risk of delirium, and a modest reduction in duration of mechanical ventilation and ICU stay, but increased the risks of bradycardia and hypotension.

Original languageEnglish
Pages (from-to)811-840
Number of pages30
JournalIntensive Care Medicine
Volume48
Issue number7
DOIs
Publication statusPublished - Jul 2022
Externally publishedYes

Keywords

  • Delirium
  • Dexmedetomidine
  • Intensive care unit
  • Invasive mechanical ventilation
  • Sedation

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