A comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: A systematic review and meta-analysis
The use of dexmedetomidine rather than midazolam may improve ICU outcomes. We summarized the available recent evidence to further verify this conclusion. An electronic search of PubMed, Medline, Embase, Cochrane Library, and Web of Science was conducted. Risk ratios (RR) were used for binary categor...
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| creator | Wen, Jiaxuan Ding, Xueying Liu, Chen Jiang, Wenyu Xu, Yingrui Wei, Xiuhong Liu, Xin |
| description | The use of dexmedetomidine rather than midazolam may improve ICU outcomes. We summarized the available recent evidence to further verify this conclusion.
An electronic search of PubMed, Medline, Embase, Cochrane Library, and Web of Science was conducted. Risk ratios (RR) were used for binary categorical variables, and for continuous variables, weighted mean differences (WMD) were calculated, the effect sizes are expressed as 95% confidence intervals (CI), and trial sequential analysis was performed.
16 randomized controlled trials were enrolled 2035 patients in the study. Dexmedetomidine as opposed to midazolam achieved a shorter length of stay in ICU (MD = -2.25, 95%CI = -2.94, -1.57, p |
| doi_str_mv | 10.1371/journal.pone.0294292 |
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An electronic search of PubMed, Medline, Embase, Cochrane Library, and Web of Science was conducted. Risk ratios (RR) were used for binary categorical variables, and for continuous variables, weighted mean differences (WMD) were calculated, the effect sizes are expressed as 95% confidence intervals (CI), and trial sequential analysis was performed.
16 randomized controlled trials were enrolled 2035 patients in the study. Dexmedetomidine as opposed to midazolam achieved a shorter length of stay in ICU (MD = -2.25, 95%CI = -2.94, -1.57, p<0.0001), lower risk of delirium (RR = 0.63, 95%CI = 0.50, 0.81, p = 0.0002), and shorter duration of mechanical ventilation (MD = -0.83, 95%CI = -1.24, -0.43, p<0.0001). The association between dexmedetomidine and bradycardia was also found to be significant (RR 2.21, 95%CI 1.31, 3.73, p = 0.003). We found no difference in hypotension (RR = 1.44, 95%CI = 0.87, 2.38, P = 0.16), mortality (RR = 1.02, 95%CI = 0.83, 1.25, P = 0.87), neither in terms of adverse effects requiring intervention, hospital length of stay, or sedation effects.
Combined with recent evidence, compared with midazolam, dexmedetomidine decreased the risk of delirium, mechanical ventilation, length of stay in the ICU, as well as reduced patient costs. But dexmedetomidine could not reduce mortality and increased the risk of bradycardia.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0294292</identifier><identifier>PMID: 37963140</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Anesthesia ; Artificial respiration ; Benzodiazepines ; Bias ; Bradycardia ; Cardiac arrhythmia ; Clinical trials ; Complications and side effects ; Delirium ; Dexmedetomidine ; Dexmedetomidine - adverse effects ; Handbooks ; Humans ; Hypnotics and Sedatives - adverse effects ; Hypotension ; Intensive care ; Intensive Care Units ; Length of stay ; Mechanical ventilation ; Medical ethics ; Mental disorders ; Meta-analysis ; Midazolam ; Midazolam - adverse effects ; Mortality ; Nervous system ; Patient outcomes ; Patients ; Respiration, Artificial ; Risk ; Risk reduction ; Sequential analysis ; Software ; Systematic review ; Ventilation ; Ventilators</subject><ispartof>PloS one, 2023-11, Vol.18 (11), p.e0294292-e0294292</ispartof><rights>Copyright: © 2023 Wen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Wen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Wen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c637t-778a85d37eabe2663cf653f2f77226b83194e4449466b36a072be52a41583c1a3</citedby><cites>FETCH-LOGICAL-c637t-778a85d37eabe2663cf653f2f77226b83194e4449466b36a072be52a41583c1a3</cites><orcidid>0009-0009-9798-407X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,866,2106,2932,23875,27933,27934</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37963140$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Savvas, Ioannis</contributor><creatorcontrib>Wen, Jiaxuan</creatorcontrib><creatorcontrib>Ding, Xueying</creatorcontrib><creatorcontrib>Liu, Chen</creatorcontrib><creatorcontrib>Jiang, Wenyu</creatorcontrib><creatorcontrib>Xu, Yingrui</creatorcontrib><creatorcontrib>Wei, Xiuhong</creatorcontrib><creatorcontrib>Liu, Xin</creatorcontrib><title>A comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: A systematic review and meta-analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The use of dexmedetomidine rather than midazolam may improve ICU outcomes. We summarized the available recent evidence to further verify this conclusion.
An electronic search of PubMed, Medline, Embase, Cochrane Library, and Web of Science was conducted. Risk ratios (RR) were used for binary categorical variables, and for continuous variables, weighted mean differences (WMD) were calculated, the effect sizes are expressed as 95% confidence intervals (CI), and trial sequential analysis was performed.
16 randomized controlled trials were enrolled 2035 patients in the study. Dexmedetomidine as opposed to midazolam achieved a shorter length of stay in ICU (MD = -2.25, 95%CI = -2.94, -1.57, p<0.0001), lower risk of delirium (RR = 0.63, 95%CI = 0.50, 0.81, p = 0.0002), and shorter duration of mechanical ventilation (MD = -0.83, 95%CI = -1.24, -0.43, p<0.0001). The association between dexmedetomidine and bradycardia was also found to be significant (RR 2.21, 95%CI 1.31, 3.73, p = 0.003). We found no difference in hypotension (RR = 1.44, 95%CI = 0.87, 2.38, P = 0.16), mortality (RR = 1.02, 95%CI = 0.83, 1.25, P = 0.87), neither in terms of adverse effects requiring intervention, hospital length of stay, or sedation effects.
Combined with recent evidence, compared with midazolam, dexmedetomidine decreased the risk of delirium, mechanical ventilation, length of stay in the ICU, as well as reduced patient costs. But dexmedetomidine could not reduce mortality and increased the risk of bradycardia.</description><subject>Anesthesia</subject><subject>Artificial respiration</subject><subject>Benzodiazepines</subject><subject>Bias</subject><subject>Bradycardia</subject><subject>Cardiac arrhythmia</subject><subject>Clinical trials</subject><subject>Complications and side effects</subject><subject>Delirium</subject><subject>Dexmedetomidine</subject><subject>Dexmedetomidine - adverse effects</subject><subject>Handbooks</subject><subject>Humans</subject><subject>Hypnotics and Sedatives - adverse effects</subject><subject>Hypotension</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Length of stay</subject><subject>Mechanical ventilation</subject><subject>Medical ethics</subject><subject>Mental disorders</subject><subject>Meta-analysis</subject><subject>Midazolam</subject><subject>Midazolam - adverse effects</subject><subject>Mortality</subject><subject>Nervous 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comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: A systematic review and meta-analysis</title><author>Wen, Jiaxuan ; Ding, Xueying ; Liu, Chen ; Jiang, Wenyu ; Xu, Yingrui ; Wei, Xiuhong ; Liu, Xin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c637t-778a85d37eabe2663cf653f2f77226b83194e4449466b36a072be52a41583c1a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anesthesia</topic><topic>Artificial respiration</topic><topic>Benzodiazepines</topic><topic>Bias</topic><topic>Bradycardia</topic><topic>Cardiac arrhythmia</topic><topic>Clinical trials</topic><topic>Complications and side effects</topic><topic>Delirium</topic><topic>Dexmedetomidine</topic><topic>Dexmedetomidine - adverse effects</topic><topic>Handbooks</topic><topic>Humans</topic><topic>Hypnotics and Sedatives - adverse 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Ioannis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: A systematic review and meta-analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-11-14</date><risdate>2023</risdate><volume>18</volume><issue>11</issue><spage>e0294292</spage><epage>e0294292</epage><pages>e0294292-e0294292</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The use of dexmedetomidine rather than midazolam may improve ICU outcomes. We summarized the available recent evidence to further verify this conclusion.
An electronic search of PubMed, Medline, Embase, Cochrane Library, and Web of Science was conducted. Risk ratios (RR) were used for binary categorical variables, and for continuous variables, weighted mean differences (WMD) were calculated, the effect sizes are expressed as 95% confidence intervals (CI), and trial sequential analysis was performed.
16 randomized controlled trials were enrolled 2035 patients in the study. Dexmedetomidine as opposed to midazolam achieved a shorter length of stay in ICU (MD = -2.25, 95%CI = -2.94, -1.57, p<0.0001), lower risk of delirium (RR = 0.63, 95%CI = 0.50, 0.81, p = 0.0002), and shorter duration of mechanical ventilation (MD = -0.83, 95%CI = -1.24, -0.43, p<0.0001). The association between dexmedetomidine and bradycardia was also found to be significant (RR 2.21, 95%CI 1.31, 3.73, p = 0.003). We found no difference in hypotension (RR = 1.44, 95%CI = 0.87, 2.38, P = 0.16), mortality (RR = 1.02, 95%CI = 0.83, 1.25, P = 0.87), neither in terms of adverse effects requiring intervention, hospital length of stay, or sedation effects.
Combined with recent evidence, compared with midazolam, dexmedetomidine decreased the risk of delirium, mechanical ventilation, length of stay in the ICU, as well as reduced patient costs. But dexmedetomidine could not reduce mortality and increased the risk of bradycardia.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>37963140</pmid><doi>10.1371/journal.pone.0294292</doi><tpages>e0294292</tpages><orcidid>https://orcid.org/0009-0009-9798-407X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS) Journals Open Access; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Anesthesia Artificial respiration Benzodiazepines Bias Bradycardia Cardiac arrhythmia Clinical trials Complications and side effects Delirium Dexmedetomidine Dexmedetomidine - adverse effects Handbooks Humans Hypnotics and Sedatives - adverse effects Hypotension Intensive care Intensive Care Units Length of stay Mechanical ventilation Medical ethics Mental disorders Meta-analysis Midazolam Midazolam - adverse effects Mortality Nervous system Patient outcomes Patients Respiration, Artificial Risk Risk reduction Sequential analysis Software Systematic review Ventilation Ventilators |
| title | A comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: A systematic review and meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-02T11%3A02%3A54IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20comparation%20of%20dexmedetomidine%20and%20midazolam%20for%20sedation%20in%20patients%20with%20mechanical%20ventilation%20in%20ICU:%20A%20systematic%20review%20and%20meta-analysis&rft.jtitle=PloS%20one&rft.au=Wen,%20Jiaxuan&rft.date=2023-11-14&rft.volume=18&rft.issue=11&rft.spage=e0294292&rft.epage=e0294292&rft.pages=e0294292-e0294292&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0294292&rft_dat=%3Cgale_plos_%3EA772825112%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3069280384&rft_id=info:pmid/37963140&rft_galeid=A772825112&rft_doaj_id=oai_doaj_org_article_846584d7e3504b56a1ea349ca1ac14c8&rfr_iscdi=true |