Dexmedetomidine Versus Midazolam/Propofol Sedation Reduces Delirium In The Intensive Care Unit: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials

Background: Delirium is a serious complication for intensive care unit (ICU) patients. Preventing delirium by dexmedetomidine administration for sedative is still controversial. This meta-analysis aims to analyze the different occurrence of delirium between dexmedetomidine and midazolam/propofol administration for ICU patients. Methods: We searched multiple electronic databases including Embase, PubMed, Google Scholar, and The Cochrane Library and Cochrane Central Register of Controlled Trials (CENTRAL), and the results were updated in December 2016. All statistical analysis utilizing Review Manager was performed, and the Cochrane Collaboration's software was used only for preparation and maintenance of Cochrane systematic reviews. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement methodology for validation. Results: Eight studies, with a sample size ranged from 23 to 998, for a total number of 2182 participants were included in this meta-analysis. Pooled subgroup analysis suggested that dexmedetomidine had an intense correlation with reducing the occurrence of delirium compared with midazolam/propofol administration for ICU patients (OR: 0.47; 95% CI: 0.26-0.84; P < 0.00001). Both the duration of mechanical ventilation (MV) and Length of ICU stay statistically significant shorter was associated with dexmedetomidine for ICU patients (Weighted Mean Difference [WMD]: -2.27 D; 95% confidence interval [CI]: -3.59 to -0.95; P < 0.00001) and (WMD: -1.62 D; 95% CI: -1.75 to -1.50; P = 0.03). Conclusions: Current evidence demonstrates that dexmedetomidine, administered as sedative agent for ICU-MV patients, is related to conspicuously lower rates of delirium, shorter duration of MV, and length of ICU. Nevertheless, the overall outcomes of this meta-analysis can be impacted by drug interactions, neurocognitive assessment method, and clinical heterogeneity.