Clinical benefits of dexmedetomidine versus propofol in adult intensive care unit patients: a meta-analysis of randomized clinical trials

Background: This meta-analysis was performed to assess the influence of dexmedetomidine and propofol for adult intensive care unit (ICU) sedation, with respect to patient outcomes and adverse events. Materials and methods: A systematic review was conducted of all randomized controlled trials exploring the clinical benefits of dexmedetomidine versus propofol for sedation in adult intensive care patients. The primary outcomes of this study were length of ICU stay, duration of mechanical ventilation, and risk of ICU mortality. Secondary outcomes included risk of delirium, hypotension, bradycardia and hypertension. Results: Ten randomized controlled trials, involving 1202 patients, were included. Dexmedetomidine significantly reduced the length of ICU stay by < 1 d (five studies, 655 patients; mean difference, -0.81 d; 95% confidence interval [CI], -1.48 to -0.15) and the incidence of delirium (three studies, 658 patients; relative risk [RR], 0.40; 95% CI, 0.22-0.74) in comparison with propofol, whereas there was no difference in the duration of mechanical ventilation (five studies, 895 patients; mean difference, 0.53 h; 95% CI - 2.66 to 3.72) or ICU mortality (five studies, 267 patients; RR, 0.83; 95% CI, 0.32-2.12) between these two drugs. Dexmedetomidine was associated with an increased risk of hypertension (three studies, 846 patients; RR, 1.56; 95% CI, 1.11-2.20) compared with propofol. Other adverse event rates were similar between dexmedetomidine and propofol groups. Conclusions: For ICU patient sedation, dexmedetomidine may offer advantages over propofol in terms of decrease in the length of ICU stay and the risk of delirium. However, transient hypertension may occur when dexmedetomidine is administered with a loading dose or at high infusion rates. (C) 2013 Elsevier Inc. All rights reserved.