Abstract
Purpose Children undergoing mechanical ventilation 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, yet its efficacy and safety 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 efficacy and adverse effects of dexmedetomidine in such patients.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 efficacy 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 significantly reduced the duration of mechanical ventilation (MD -3.54 h, 95% CI, -6.49 to -0.59), particularly 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 (OR 6.14, 95% CI, 2.20 to 17.12) and hypotension (OR 8.14, 95% CI, 1.37 to 48.31), with no significant difference observed in the incidence of delirium (OR 0.61, 95% CI, 0.16 to 2.31) in comparison to other sedatives.Conclusion Although dexmedetomidine notably diminished the duration of mechanical ventilation, 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.