Efficacy and safety of analgosedation with dexmedetomidine in critically ill mechanically ventilated children: a systematic review and meta-analysis of randomized controlled trials
Bibliographic record
Abstract
Objective: Dexmedetomidine is an increasingly popular analgosedative in critically ill children receiving invasive mechanical ventilation (IMV). We conducted a systematic review to evaluate the efficacy of dexmedetomidine compared to other analgosedatives in this population. Data sources: Seven electronic databases and trial registries to July 2024, without language restrictions. Study selection: Randomized controlled trials comparing dexmedetomidine to other analgosedatives in critically ill children receiving IMV. Data extraction and synthesis: Independently and in duplicate, we conducted data extraction, risk of bias assessment, and certainty assessment using Grading of Recommendations, Assessment, Development, and Evaluation. We conducted random-effects meta-analyses, calculating pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals. Results: = 592 patients). Pooled analyses demonstrated dexmedetomidine has little to no effect on IMV duration (MD -2.2 h [-3.3, -1.1]; moderate certainty), clinically important bradycardia (RR 1.42 [0.45, 4.49]; moderate certainty), or clinically important hypotension (RR 1.35 [0.48, 3.82]; moderate certainty). Dexmedetomidine may reduce delirium risk (RR 0.83 [0.64, 1.07]; low certainty), but impact on withdrawal is uncertain (RR 0.93 [0.55, 1.59]; very low certainty). A narrative synthesis was used to evaluate dexmedetomidine sedation efficacy, demonstrating very low certainty in attaining sedation target. One trial reported on long-term outcomes. Conclusions: Twelve trials evaluating dexmedetomidine have been conducted to date, with low or very low certainty for its impact upon delirium, withdrawal, and long-term outcomes. Future analgosedation trials require attention to intervention design, outcome selection and reporting to improve certainty in critical outcomes. Supplementary Information: The online version contains supplementary material available at 10.1007/s44253-025-00091-4.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.050 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.033 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".