In Kyung Lee, Kyeong Hun Lee, Hye-Ji Han, In Young Choi, Na Jin Kim, Kyunghoon Kim
{"title":"Dexmedetomidine in Mechanically Ventilated Critically Ill Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"In Kyung Lee, Kyeong Hun Lee, Hye-Ji Han, In Young Choi, Na Jin Kim, Kyunghoon Kim","doi":"10.3349/ymj.2024.0299","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Children undergoing mechanical ventilation (MV) in the pediatric intensive care unit (PICU) require effective sedation to reduce anxiety and discomfort. Dexmedetomidine, an α2-receptor agonist, presents as a viable sedative alternative. However, its clinical outcomes for critically ill, mechanically ventilated children remain to be fully established. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the clinical outcomes and adverse effects of dexmedetomidine in such patients.</p><p><strong>Materials and methods: </strong>A systematic search was conducted up to April 2024. RCTs that compare dexmedetomidine with other sedatives in mechanically ventilated children were included. This analysis focused on both the clinical and safety outcomes through meta-analysis.</p><p><strong>Results: </strong>Included in the analysis were eight trials, involving a total of 387 mechanically ventilated children. Compared to other sedatives, dexmedetomidine reduced the duration of MV [mean difference -3.54 hours; 95% confidence interval (CI), -6.49 to -0.59], particularly in post-operative patients and when compared to fentanyl. However, dexmedetomidine did not significantly impact the length of ICU stay, duration of sedation, or the necessity for additional sedatives. Dexmedetomidine was associated with a significantly increased risk of bradycardia [odds ratio (OR) 6.14; 95% CI, 2.20 to 17.12] and hypotension (OR 8.14; 95% CI, 1.37 to 48.31) compared to other sedatives.</p><p><strong>Conclusion: </strong>Although dexmedetomidine notably diminished the duration of MV, the potential for adverse effects necessitates further investigation. Large RCTs are needed to validate our findings and refine sedation management in mechanically ventilated children in PICU.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 8","pages":"473-481"},"PeriodicalIF":2.8000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303668/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Yonsei Medical Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3349/ymj.2024.0299","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Children undergoing mechanical ventilation (MV) in the pediatric intensive care unit (PICU) require effective sedation to reduce anxiety and discomfort. Dexmedetomidine, an α2-receptor agonist, presents as a viable sedative alternative. However, its clinical outcomes for critically ill, mechanically ventilated children remain to be fully established. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the clinical outcomes and adverse effects of dexmedetomidine in such patients.
Materials and methods: A systematic search was conducted up to April 2024. RCTs that compare dexmedetomidine with other sedatives in mechanically ventilated children were included. This analysis focused on both the clinical and safety outcomes through meta-analysis.
Results: Included in the analysis were eight trials, involving a total of 387 mechanically ventilated children. Compared to other sedatives, dexmedetomidine reduced the duration of MV [mean difference -3.54 hours; 95% confidence interval (CI), -6.49 to -0.59], particularly in post-operative patients and when compared to fentanyl. However, dexmedetomidine did not significantly impact the length of ICU stay, duration of sedation, or the necessity for additional sedatives. Dexmedetomidine was associated with a significantly increased risk of bradycardia [odds ratio (OR) 6.14; 95% CI, 2.20 to 17.12] and hypotension (OR 8.14; 95% CI, 1.37 to 48.31) compared to other sedatives.
Conclusion: Although dexmedetomidine notably diminished the duration of MV, the potential for adverse effects necessitates further investigation. Large RCTs are needed to validate our findings and refine sedation management in mechanically ventilated children in PICU.
期刊介绍:
The goal of the Yonsei Medical Journal (YMJ) is to publish high quality manuscripts dedicated to clinical or basic research. Any authors affiliated with an accredited biomedical institution may submit manuscripts of original articles, review articles, case reports, brief communications, and letters to the Editor.