{"title":"重症监护病房老年患者使用咪达唑仑、芬太尼、异丙酚、氯胺酮和右美托咪定与谵妄发生率的关系：一项系统综述","authors":"Willian Setubal Dos Santos, Omar Carrión-Torres, Matheus Galvão Valadares Bertolini Mussalem, Vinicius Santos Baptista, Samira Yarak","doi":"10.1590/1516-3180.2024.0311R1.14072025","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Delirium is a common and serious complication among elderly patients in intensive care units (ICUs), and is often associated with increased morbidity and mortality rates. The choice of sedoanalgesic may influence the incidence of delirium; however, the evidence remains unclear, particularly in the elderly population.</p><p><strong>Objectives: </strong>To evaluate the association between the use of different sedoanalgesics and the incidence of delirium in elderly ICU patients, based on data from randomized clinical trials.</p><p><strong>Design and setting: </strong>This systematic review was conducted using data from randomized clinical trials performed in various ICU settings.</p><p><strong>Methods: </strong>A systematic search of the MEDLINE, Embase, and CENTRAL databases was performed in January 2024. The review included randomized clinical trials involving patients aged 60 years or older that examined the relationship between sedoanalgesics (midazolam, fentanyl, propofol, ketamine, and dexmedetomidine) and delirium incidence. Studies involving COVID-19 patients and non-randomized studies were excluded.</p><p><strong>Results: </strong>A total of 1,331 patients from six studies were included. The mean age of the patients ranged from 71 to 74.7 years. Four studies compared dexmedetomidine with propofol; two found no significant difference in delirium incidence, whereas two suggested a lower incidence with dexmedetomidine. The remaining studies compared propofol with ketamine and dexmedetomidine with midazolam and showed no significant differences in the incidence of delirium.</p><p><strong>Conclusions: </strong>Dexmedetomidine may be associated with a lower incidence of delirium than propofol or midazolam in elderly ICU patients. However, further research is needed to confirm these findings and explore the factors contributing to delirium in this population.</p><p><strong>Systematic review registration: </strong>Registered with PROSPERO, CRD42024575693, available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=575693.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 6","pages":"e20240311"},"PeriodicalIF":1.6000,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503417/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association between the use of midazolam, fentanyl, propofol, ketamine, and dexmedetomidine and the incidence of delirium in elderly patients in intensive care units: a systematic review.\",\"authors\":\"Willian Setubal Dos Santos, Omar Carrión-Torres, Matheus Galvão Valadares Bertolini Mussalem, Vinicius Santos Baptista, Samira Yarak\",\"doi\":\"10.1590/1516-3180.2024.0311R1.14072025\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Delirium is a common and serious complication among elderly patients in intensive care units (ICUs), and is often associated with increased morbidity and mortality rates. The choice of sedoanalgesic may influence the incidence of delirium; however, the evidence remains unclear, particularly in the elderly population.</p><p><strong>Objectives: </strong>To evaluate the association between the use of different sedoanalgesics and the incidence of delirium in elderly ICU patients, based on data from randomized clinical trials.</p><p><strong>Design and setting: </strong>This systematic review was conducted using data from randomized clinical trials performed in various ICU settings.</p><p><strong>Methods: </strong>A systematic search of the MEDLINE, Embase, and CENTRAL databases was performed in January 2024. The review included randomized clinical trials involving patients aged 60 years or older that examined the relationship between sedoanalgesics (midazolam, fentanyl, propofol, ketamine, and dexmedetomidine) and delirium incidence. Studies involving COVID-19 patients and non-randomized studies were excluded.</p><p><strong>Results: </strong>A total of 1,331 patients from six studies were included. The mean age of the patients ranged from 71 to 74.7 years. Four studies compared dexmedetomidine with propofol; two found no significant difference in delirium incidence, whereas two suggested a lower incidence with dexmedetomidine. The remaining studies compared propofol with ketamine and dexmedetomidine with midazolam and showed no significant differences in the incidence of delirium.</p><p><strong>Conclusions: </strong>Dexmedetomidine may be associated with a lower incidence of delirium than propofol or midazolam in elderly ICU patients. However, further research is needed to confirm these findings and explore the factors contributing to delirium in this population.</p><p><strong>Systematic review registration: </strong>Registered with PROSPERO, CRD42024575693, available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=575693.</p>\",\"PeriodicalId\":49574,\"journal\":{\"name\":\"Sao Paulo Medical Journal\",\"volume\":\"143 6\",\"pages\":\"e20240311\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-10-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503417/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Sao Paulo Medical Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1590/1516-3180.2024.0311R1.14072025\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Sao Paulo Medical Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1590/1516-3180.2024.0311R1.14072025","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Association between the use of midazolam, fentanyl, propofol, ketamine, and dexmedetomidine and the incidence of delirium in elderly patients in intensive care units: a systematic review.
Background: Delirium is a common and serious complication among elderly patients in intensive care units (ICUs), and is often associated with increased morbidity and mortality rates. The choice of sedoanalgesic may influence the incidence of delirium; however, the evidence remains unclear, particularly in the elderly population.
Objectives: To evaluate the association between the use of different sedoanalgesics and the incidence of delirium in elderly ICU patients, based on data from randomized clinical trials.
Design and setting: This systematic review was conducted using data from randomized clinical trials performed in various ICU settings.
Methods: A systematic search of the MEDLINE, Embase, and CENTRAL databases was performed in January 2024. The review included randomized clinical trials involving patients aged 60 years or older that examined the relationship between sedoanalgesics (midazolam, fentanyl, propofol, ketamine, and dexmedetomidine) and delirium incidence. Studies involving COVID-19 patients and non-randomized studies were excluded.
Results: A total of 1,331 patients from six studies were included. The mean age of the patients ranged from 71 to 74.7 years. Four studies compared dexmedetomidine with propofol; two found no significant difference in delirium incidence, whereas two suggested a lower incidence with dexmedetomidine. The remaining studies compared propofol with ketamine and dexmedetomidine with midazolam and showed no significant differences in the incidence of delirium.
Conclusions: Dexmedetomidine may be associated with a lower incidence of delirium than propofol or midazolam in elderly ICU patients. However, further research is needed to confirm these findings and explore the factors contributing to delirium in this population.
Systematic review registration: Registered with PROSPERO, CRD42024575693, available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=575693.
期刊介绍：
Published bimonthly by the Associação Paulista de Medicina, the journal accepts articles in the fields of clinical health science (internal medicine, gynecology and obstetrics, mental health, surgery, pediatrics and public health). Articles will be accepted in the form of original articles (clinical trials, cohort, case-control, prevalence, incidence, accuracy and cost-effectiveness studies and systematic reviews with or without meta-analysis), narrative reviews of the literature, case reports, short communications and letters to the editor. Papers with a commercial objective will not be accepted.
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