Safety and adverse events associated with dexmedetomidine for sedation in adult ICU patients: a systematic review and meta-analysis
Notice bibliographique
Résumé
Background Dexmedetomidine (DEX) is increasingly used for sedation in critically ill adults due to its favorable pharmacokinetic profile and potential benefits over traditional sedatives. However, concerns persist regarding its cardiovascular safety. This meta-analysis comprehensively evaluates the incidence and nature of adverse events associated with DEX sedation in adult intensive care unit (ICU) patients. Methods We conducted a systematic review and meta-analysis according to PRISMA 2020 guidelines. A meta-analysis search of PubMed, Embase, and Cochrane Library was conducted from database inception to June 18, 2025 for randomized controlled trials (RCTs), prospective/retrospective cohort studies, or descriptive studies with a comparator group, reporting safety outcomes in adults receiving DEX for ICU sedation. Primary outcomes were hemodynamic adverse events including hypotension, bradycardia, tachycardia. Data were pooled using fixed-effects models, calculating odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I 2 statistics. Risk of bias was evaluated using Cochrane RoB 2.0 for RCTs and Newcastle-Ottawa Scale (NOS) for observational studies. GRADE assessed evidence certainty. Results Ten studies (7 randomized controlled trials, 3 cohorts; total n = 1,456 patients) were included. Meta-analysis demonstrated a significantly increased risk of bradycardia with dexmedetomidine versus controls (9 studies, n = 1,590; pooled OR = 2.38, 95% CI [1.77, 3.21], p < 0.00001; I 2 = 0%; high certainty evidence). No significant increase in overall hypotension risk was observed (9 studies, n = 1,422; OR = 1.15, 95% CI [0.91, 1.47], p = 0.25; I 2 = 44%; moderate certainty), though subgroup analyses indicated elevated risks in vulnerable populations. A modest but significant increase in tachycardia risk was found (4 studies, n = 1,084; OR = 1.38, 95% CI [1.03, 1.83], p = 0.03), with substantial heterogeneity (I 2 = 93%; low certainty) suggesting context-dependent effects. Risk of bias was generally low for RCTs, while observational studies demonstrated good quality but limited confounding adjustment. Conclusion Dexmedetomidine use for ICU sedation is consistently associated with a significantly increased risk of bradycardia. While the overall risk of hypotension was not significantly elevated, specific patient populations may be vulnerable. Tachycardia risk appears modest but highly variable. These findings underscore the necessity for careful patient selection, continuous hemodynamic monitoring particularly heart rate, and cautious titration when using DEX in critically ill adults. Future research should focus on high-risk subgroups and standardize adverse event definitions.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,012 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».