Differences in efficacy and safety of midazolam vs. dexmedetomidine in critically ill patients: A meta‑analysis of randomized controlled trial

Zhou,Wen-Jun; Liu,Mei; Fan,Xue-Peng

doi:10.3892/etm.2020.9297

Differences in efficacy and safety of midazolam vs. dexmedetomidine in critically ill patients: A meta‑analysis of randomized controlled trial

Authors:
- Wen-Jun Zhou
- Mei Liu
- Xue-Peng Fan
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Affiliations: Department of Anesthesiology, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, Hubei 430015, P.R. China, Department of Intensive Care Unit, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
Published online on: December 17, 2020 https://doi.org/10.3892/etm.2020.9297
Article Number: 156
Copyright: © Zhou et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present study aimed to compare the efficacy and safety of dexmedetomidine and midazolam in patients that are critically ill. Full text articles reporting the clinical effects and complications of dexmedetomidine and midazolam were retrieved from multiple databases. Review Manager 5.0 was adopted for meta‑analysis, sensitivity and bias analysis. Finally, a total of 1,379 patients from 8 studies, which met the eligibility criteria, were included. The meta‑analysis suggested that the length of stay at the intensive care unit [mean absolute difference (MD)=‑1.80; 95% confidence interval (CI), ‑2.13, ‑1.48; P<0.00001; P‑value for heterogeneity=0.41; I^²=3%], time to extubation (MD=‑2.18; 95% CI, ‑2.66, ‑1.69; P<0.00001; P‑value for heterogeneity=0.84; I^²=0%) and delirium (MD=0.46; 95% CI, 0.37, 0.57; P<0.00001; P‑value for heterogeneity=0.65; I^²=0%) was higher following midazolam treatment compared with dexmedetomidine, while bradycardia [odds ratio (OR)=5.03; 95% CI, 3.86, 6.57; P<0.00001; P‑value for heterogeneity=0.13; I^²=38%] was higher in dexmedetomidine treated patients compared with midazolam. However, no difference was observed in the incidence of hypotension (OR=0.88; 95% CI, 0.70, 1.10; P=0.26; P‑value for heterogeneity=0.99; I^²=0%) and mortality (OR=0.96; 95% CI, 0.74, 1.25; P=0.77; P‑value for heterogeneity=0.99; I²=0%). Taking clinical effects and safety into account, the present study suggested dexmedetomidine to be the preferred option of anesthesia for patients that are critically ill.

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1	Chang YF, Chao A, Shih PY, Hsu YC, Lee CT, Tien YW, Yeh YC and Chen LW: NTUH Center of Microcirculation Medical Research (NCMMR). Comparison of dexmedetomidine versus propofol on hemodynamics in surgical critically ill patients. J Surg Res. 228:194–200. 2018.PubMed/NCBI View Article : Google Scholar
2	Tan JA and Ho KM: Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients: A meta-analysis. Intensive Care Med. 36:926–939. 2010.PubMed/NCBI View Article : Google Scholar
3	Memiş D, Hekimoğlu S, Vatan I, Yandim T, Yüksel M and Süt N: Effects of midazolam and dexmedetomidine on inflammatory responses and gastric intramucosal pH to sepsis, in critically ill patients. Br J Anaesth. 98:550–552. 2007.PubMed/NCBI View Article : Google Scholar
4	Shehabi Y, Nakae H, Hammond N, Bass F, Nicholson L and Chen J: The effect of dexmedetomidine on agitation during weaning of mechanical ventilation in critically ill patients. Anaesth Intensive Care. 38:82–90. 2010.PubMed/NCBI View Article : Google Scholar
5	Gerlach AT, Dasta JF, Steinberg S, Martin LC and Cook CH: A new dosing protocol reduces dexmedetomidine-associated hypotension in critically ill surgical patients. J Crit Care. 24(568)2009.PubMed/NCBI View Article : Google Scholar
6	Iirola T, Aantaa R, Laitio R, Kentala E, Lahtinen M, Wighton A, Garratt C, Ahtola-Sätilä T and Olkkola KT: Pharmacokinetics of prolonged infusion of high-dose dexmedetomidine in critically ill patients. Crit Care. 15(R257)2011.PubMed/NCBI View Article : Google Scholar
7	Gupta P, Whiteside W, Sabati A, Tesoro TM, Gossett JM, Tobias JD and Roth SJ: Safety and efficacy of prolonged dexmedetomidine use in critically ill children with heart disease*. Pediatr Crit Care Med. 13(660)2012.PubMed/NCBI View Article : Google Scholar
8	Guinter JR and Kristeller JL: Prolonged infusions of dexmedetomidine in critically ill patients. Am J Health Syst Pharm. 67:1246–1253. 2010.PubMed/NCBI View Article : Google Scholar
9	Burbano NH, Otero AV, Berry DE, Orr RA and Munoz RA: Discontinuation of prolonged infusions of dexmedetomidine in critically ill children with heart disease. Intensive Care Med. 38:300–307. 2012.PubMed/NCBI View Article : Google Scholar
10	Lin H, Faraklas I, Sampson C, Saffle JR and Cochran Al: Use of dexmedetomidine for sedation in critically ill mechanically ventilated pediatric burn patients. J Burn Care Res. 32(98)2008.PubMed/NCBI View Article : Google Scholar
11	Demuro JP, Botros DG, Wirkowski E and Hanna AF: Use of dexmedetomidine for the treatment of alcohol withdrawal syndrome in critically ill patients: A retrospective case series. J Anesth. 26:601–605. 2012.PubMed/NCBI View Article : Google Scholar
12	Kress JP, O'Connor MF, Pohlman AS, Olson D, Lavoie A, Toledano A and Hall JB: Sedation of critically ill patients during mechanical ventilation. A comparison of propofol and midazolam. Am J Respir Crit Care Med. 153:1012–1018. 1996.PubMed/NCBI View Article : Google Scholar
13	Shelly MP, Mendel L and Park GR: Failure of critically ill patients to metabolise midazolam. Anaesthesia. 42:619–626. 1987.PubMed/NCBI View Article : Google Scholar
14	Barrientos-Vega R, Mar Sánchez-Soria M, Morales-García C, Robas-Gómez A, Cuena-Boy R and Ayensa-Rincon A: Prolonged sedation of critically ill patients with midazolam or propofol: Impact on weaning and costs. Crit Care Med. 25:33–40. 1997.PubMed/NCBI View Article : Google Scholar
15	Alexopoulou C, Kondili E, Diamantaki E, Psarologakis C, Kokkini S, Bolaki M and Georgopoulos D: Effects of dexmedetomidine on sleep quality in Critically Ill patients: A pilot study. Anesthesiology. 121:801–807. 2014.PubMed/NCBI View Article : Google Scholar
16	Benedict N, Felbinger M, Ridenour T, Anthes A, Altawalbeh S and Kane-Gill S: Correlation of patient-reported outcomes of sedation and sedation assessment scores in critically ill patients. J Crit Care. 29:1132.e5–e9. 2014.PubMed/NCBI View Article : Google Scholar
17	Ludtke KA, Stanley KS, Yount NL and Gerkin RD: Retrospective review of Critically Ill patients experiencing alcohol withdrawal: Dexmedetomidine versus propofol and/or lorazepam continuous infusions. Hosp Pharm. 50:208–213. 2015.PubMed/NCBI View Article : Google Scholar
18	Memiş D, Dökmeci D, Karamanlioğlu B, Turan A and Türe M: A comparison of the effect on gastric emptying of propofol or dexmedetomidine in critically ill patients: Preliminary study. Eur J Anaesthesiol. 23:700–704. 2006.PubMed/NCBI View Article : Google Scholar
19	Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, et al: Dexmedetomidine vs midazolam for sedation of critically Ill patients: A randomized trial. JAMA. 301:489–499. 2009.PubMed/NCBI View Article : Google Scholar
20	Shehabi Y, Ruettimann U, Adamson H, Innes R and Ickeringill M: Dexmedetomidine infusion for more than 24 hours in critically ill patients: Sedative and cardiovascular effects. Intensive Care Med. 30:2188–2196. 2004.PubMed/NCBI View Article : Google Scholar
21	Xu F, Wang Q, Chen S, Ao H and Ma J: The association between intraoperative dexmedetomidine and 1 year morbidity and mortality after cardiac surgery: A propensity matched analysis of over 1400 patients. J Clin Anesth. 50:70–75. 2018.PubMed/NCBI View Article : Google Scholar
22	Xue Y, Yuan H and Chen Y: Effects of dexmedetomidine as an adjunct in transversus abdominis plane block during gynecological laparoscopy. Exp Ther Med. 16:1131–1136. 2018.PubMed/NCBI View Article : Google Scholar
23	Hughes J, Gill A, Leach HJ, Nunn AJ, Billingham I, Ratcliffe J, Thornington R and Choonara I: A prospective study of the adverse effects of midazolam on withdrawal in critically ill children. Acta Pædiatr. 83:1194–1199. 1994.PubMed/NCBI View Article : Google Scholar
24	Spina SP and Ensom MH: Clinical pharmacokinetic monitoring of midazolam in critically ill patients. Pharmacotherapy. 27:389–398. 2007.PubMed/NCBI View Article : Google Scholar
25	Mccollam JS, O'Neil MG, Norcross ED, Byrne TK and Reeves ST: Continuous infusions of lorazepam, midazolam, and propofol for sedation of the critically ill surgery trauma patient: A prospective, randomized comparison. Crit Care Med. 27:2454–2458. 1999.PubMed/NCBI View Article : Google Scholar
26	Jacqz-Aigrain E, Daoud P, Burtin P, Maherzi S and Beaufils F: Pharmacokinetics of midazolam during continuous infusion in critically ill neonates. Eur J Clin Pharmacol. 42:329–332. 1992.PubMed/NCBI View Article : Google Scholar
27	Shafer A, Doze VA and White PF: Pharmacokinetic variability of midazolam infusions in critically ill patients. Crit Care Med. 18:1039–1041. 1990.PubMed/NCBI View Article : Google Scholar
28	Swart EL, Zuideveld KP, de Jongh J, Danhof M, Thijs LG and Strack van Schijndel RM: Comparative population pharmacokinetics of lorazepam and midazolam during long-term continuous infusion in critically ill patients. Br J Clin Pharmacol. 57:135–145. 2004.PubMed/NCBI View Article : Google Scholar
29	Dirksen MS, Vree TB and Driessen JJ: Clinical pharmacokinetics of long-term infusion of midazolam in critically ill patients-preliminary results. Anaesth Intensive Care. 15:440–444. 1987.PubMed/NCBI View Article : Google Scholar
30	Kirwan CJ, MacPhee IA, Lee T, Holt DW and Philips BJ: Acute kidney injury reduces the hepatic metabolism of midazolam in critically ill patients. Intensive Care Med. 38:76–84. 2012.PubMed/NCBI View Article : Google Scholar
31	Ma C: Effect of dexmedetomidine on postoperative delirium in elderly patients with severe diseases. Chin J Geriatr. 34:141–143. 2015.
32	Romagnoli S, Amigoni A, Blangetti I, Casella G, Chelazzi C, Forfori F, Garisto C, Mondardini MC, Moltrasio M, Pasero D, et al: Light sedation with dexmedetomidine: A practical approach for the intensivist in different ICU patients. Minerva Anestesiol. 84:731–746. 2018.PubMed/NCBI View Article : Google Scholar
33	Yao Y-Q and Dong-Xin W: The effect of dexmedetomidine on the incidence of postoperative delirium in critically ill elderly patients. J Clin Anesthesiol, 2012.