title: Dexmedetomidine as a sedative agent in critically ill patients: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time to extubation is still unclear.
  
  
  METHODS
  Pertinent studies were independently searched in BioMedCentral, PubMed, Embase, and the Cochrane Central Register of clinical trials (updated February first 2013). Randomized studies (dexmedetomidine versus any comparator) were included if including patients mechanically ventilated in an intensive care unit (ICU). Co-primary endpoints were the length of ICU stay (days) and time to extubation (hours). Secondary endpoint was mortality rate at the longest follow-up available.
  
  
  RESULTS
  The 27 included manuscripts (28 trials) randomized 3,648 patients (1,870 to dexmedetomidine and 1,778 to control). Overall analysis showed that the use of dexmedetomidine was associated with a significant reduction in length of ICU stay (weighted mean difference (WMD) = -0.79 [-1.17 to -0.40] days, p for effect <0.001) and of time to extubation (WMD = -2.74 [-3.80 to -1.65] hours, p for effect <0.001). Mortality was not different between dexmedetomidine and controls (risk ratio = 1.00 [0.84 to 1.21], p for effect = 0.9). High heterogeneity between included studies was found.
  
  
  CONCLUSIONS
  This meta-analysis of randomized controlled studies suggests that dexmedetomidine could help to reduce ICU stay and time to extubation, in critically ill patients even if high heterogeneity between studies might confound the interpretation of these results.
authors.affiliation: Anesthesia and Intensive Care Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pasin
authors.affiliation: Anesthesia and Intensive Care Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Greco
authors.affiliation: Department of Pharmacology and Anesthesiology, University Hospital of Padua, Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Feltracco
authors.affiliation: Anesthesia and Intensive Care Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Vittorio
authors.affiliation: Anesthesia and Intensive Care Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Caetano Nigro
authors.initials: CN
authors.lastname: Neto
authors.affiliation: Anesthesia and Intensive Care Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cabrini
authors.affiliation: Anesthesia and Intensive Care Department, San Raffaele Scientific Institute, Milan, Italy ; Outcomes Research Consortium, Cleveland, Ohio, United States of America.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.affiliation: Department of Medical Sciences "M. Aresu", Cagliari University, Cagliari, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Finco
authors.affiliation: Anesthesia and Intensive Care Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D060666:Airway Extubation; D001919:Bradycardia / Q000139:chemically induced; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality; D020927:Dexmedetomidine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D007022:Hypotension / Q000139:chemically induced; D007902:Length of Stay; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine