Efficacy of dexmedetomidine compared with midazolam for sedation in adult intensive care patients: a systematic review

Editor’s key points † Dexmedetomidine may offer advantages over midazolam when used for sedation in Intensive Care Unit (ICU) patients. † The authors undertook a critical appraisal of randomized controlled trials which have addressed this issue. † So far the evidence of advantages of dexmedetomidine in ICU setting remains limited. † The authors recommend more research using robust methodology and outcome measures. Summary. Patients in Intensive Care Unit (ICU) often require sedatives which commonly include midazolam and the more recently developed a2-receptor agonist, dexmedetomidine. It was our aim to compare the sedative and clinical effectiveness of dexmedetomidine vs midazolam in adults admitted to ICU, using an objective appraisal of randomized control trials. Medline, Embase, SCOPUS, Web of Knowledge, Cinhal, the United States National Library of Medicine, and the Cochrane Database of Systematic Reviews were searched using keywords: ‘dexmedetomidine’, ‘midazolam’, and ‘intensive care’. These were limited to human studies and adults (.18 yr old). Six randomized controlled trials were found and were critically appraised using a standardized appraisal method. Two papers described the time spent by each intervention group within a specified target sedation range and both found no statistically significant difference between midazolam and dexmedetomidine (P1⁄40.18 and P1⁄40.15). A third paper found no statistically significant difference in the length of time that patients were sedated within a target zone (P1⁄40.445). Two additional pilot studies did not report P values as they were insufficiently statistically powered. A final paper found that, of the eight occasions measured, patients on dexmedetomidine were more often within the target sedation range than patients on midazolam. The sedative benefits of dexmedetomidine vs midazolam remain inconclusive. While some secondary outcomes showed clinical effectiveness of dexmedetomidine, more research is needed to validate the findings of these studies.