title: Efficacy and safety of sedation with dexmedetomidine in critical care patients: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Dexmedetomidine may help physicians target a low level of sedation. Unfortunately, the impact of dexmedetomidine on major endpoints remains unclear in intensive care unit (ICU).
  
  
  METHODS
  To evaluate the association between dexmedetomidine use with efficacy and safety outcomes, two reviewers independently identified randomized controlled trials comparing dexmedetomidine with other sedative agents in non-post-cardiac surgery critically ill patients in the PubMed and Cochrane databases. Random effects models were considered if heterogeneity was detected using the DerSimonian and Laird estimation method. Statistical heterogeneity between results was assessed by examining forest plots, confidence intervals (CI) and by using the I(2) statistic. The risk of bias was assessed using the risk of bias tool.
  
  
  RESULTS
  This meta-analysis included 1994 patients from 16 randomized controlled trials. Comparators were lorazepam, midazolam and propofol. Dexmedetomidine was associated with a reduction in ICU length of stays (WMD=-0.304; 95% CI [-0.477, -0.132]; P=0.001), mechanical ventilation duration (WMD=-0.313, 95% CI [-0.523, -0.104]; P=0.003) and delirium incidence (RR=0.812, 95% CI [0.680, 0.968]; P=0.020). Dexmedetomidine is also associated with an increase in the incidence of bradycardia (RR=1.947, 95% CI [1.387, 2.733]; P=0.001) and hypotension (RR=1.264; 95% CI [1.013, 1.576]; P=0.038).
  
  
  CONCLUSIONS
  In this first meta-analysis including only randomized controlled trials related to ICU patients, dexmedetomidine was associated with a 48h reduction in ICU length of stay, mechanical ventilation duration and delirium occurrence despite a significant heterogeneity among studies. Dexmedetomidine was also associated with an increase in bradycardia and hypotension.
authors.affiliation: Perioperative Department, University Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France. Electronic address: jmconstantin@chu-clermontferrand.fr.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
authors.affiliation: Perioperative Department, University Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France.
authors.forename: Aurelien
authors.initials: A
authors.lastname: Momon
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Hôpital Européen Georges-Pompidou, Université Paris-Descartes Sorbonne Paris Cité, 75908 Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Mantz
authors.affiliation: Department of Anaesthesia and Critical Care, Michallon Hospital, boulevard de la Chantourne, 38000 Grenoble, France; Joseph-Fourier University, Grenoble Institute of Neurosciences, chemin Fortuné-Ferrini, 38042 Grenoble, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Payen
authors.affiliation: Réanimation Médico-Chirurgicale, Centre Hospitalier de Poissy-St-Germain, 78300 Poissy, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: De Jonghe
authors.affiliation: Perioperative Department, University Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Perbet
authors.affiliation: Perioperative Department, University Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Cayot
authors.affiliation: Intensive Care and Anaesthesiology Department, University of Montpellier Saint-Eloi Hospital, 34000 Montpellier, France.
authors.forename: Gerald
authors.initials: G
authors.lastname: Chanques
authors.affiliation: Biostatistics Unit, Department of Clinical Research and Innovation, University Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Perreira
mesh_terms: D003422:Critical Care / Q000379:methods*; D020927:Dexmedetomidine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine
keywords: Critical care; Delirium; Mechanical ventilation; Meta-analysis; Sedation