Secondary Outcomes.

<p>Dex: dexmedetomidine; RR: relative risk; CI: confidence interval; P: p-value.</p

Sensitivity analyses of intensive care unit stay and time to extubation.

<p>The overall analyses using weighted mean differences showed a reduction in intensive care unit stay of −0.79 [−1.17 to −0.40] days and a reduction in time to extubation of −2.74 [−3.80 to −1.65] hours in the dexmedetomidine group. It should be noted that the standard mean differences used in this table is not expressed in days or hours.</p><p>Dex: dexmedetomidine; SMD: standardized mean difference; CI: confidence interval; P: p-value; CABG: coronary artery bypass grafting; ICU: intensive care unit; NIV: non invasive ventilation.</p><p>duration of mechanical ventilation from randomization until patients were free of mechanical ventilation(including noninvasive).</p

Funnel plot for the length of ICU stay.

<p>Visual inspection of funnel plots did not identify a skewed or asymmetrical shape for the co-primary endpoints. Quantitative evaluation did not suggest a presence of publication bias, as measured by the Egger's test (p = 0.4) and Peters' test (p = 0.6). ICU = intensive care unit; SE = standard error; SMD = standardized mean difference.</p

Dexmedetomidine as a Sedative Agent in Critically Ill Patients: A Meta-Analysis of Randomized Controlled Trials

<div><p>Introduction</p><p>The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time to extubation is still unclear.</p><p>Materials and Methods</p><p>Pertinent studies were independently searched in BioMedCentral, PubMed, Embase, and the Cochrane Central Register of clinical trials (updated February first 2013). Randomized studies (dexmedetomidine versus any comparator) were included if including patients mechanically ventilated in an intensive care unit (ICU). Co-primary endpoints were the length of ICU stay (days) and time to extubation (hours). Secondary endpoint was mortality rate at the longest follow-up available.</p><p>Results</p><p>The 27 included manuscripts (28 trials) randomized 3,648 patients (1,870 to dexmedetomidine and 1,778 to control). Overall analysis showed that the use of dexmedetomidine was associated with a significant reduction in length of ICU stay (weighted mean difference (WMD) = −0.79 [−1.17 to −0.40] days, p for effect <0.001) and of time to extubation (WMD = −2.74 [−3.80 to −1.65] hours, p for effect <0.001). Mortality was not different between dexmedetomidine and controls (risk ratio = 1.00 [0.84 to 1.21], p for effect = 0.9). High heterogeneity between included studies was found.</p><p>Conclusions</p><p>This meta-analysis of randomized controlled studies suggests that dexmedetomidine could help to reduce ICU stay and time to extubation, in critically ill patients even if high heterogeneity between studies might confound the interpretation of these results.</p></div

Forest plot for the length of ICU stay.

<p>Overall analysis showed that the use of dexmedetomidine was associated with a significant reduction in length of ICU stay (SMD = −0.48 [−0.78 to −0.18] , p for effect = 0.002, p for heterogeneity <0.001, I2 = 91% with 17 studies and 2,424 patients included). ICU = intensive care unit; CI = confidence interval; SMD = standardized mean difference; N = number; SD = standard deviation; Dex = dexmedetomidine.</p

Forest plot for the time to extubation.

<p>Overall analysis showed that the use of dexmedetomidine was associated with a significant reduction of time to extubation (SMD = −0.39 [−0.66 to −0.11], p for effect = 0.005, p for heterogeneity <0.001, I2 = 93% with 24 studies and 3,478 patients included). CI = confidence interval; SMD = standardized mean difference; N = number; SD = standard deviation; Dex = dexmedetomidine.</p

Doses, sedation scales and target sedation levels.

<p>ICU: Intensive Care Unit; CPB: cardiopulmonary bypass; NA: not available.</p

Description of the 28 trials included in the meta-analysis.

<p>Dex: dexmedetomidine; ICU: Intensive Care Unit; NA: not available; RASS: Richmond Agitation Sedation Scale; BIS: BispectralIndex ; MAAS: Motor Activity Assessment Scale.</p