Evidence map›Paper›PMID 30674004›Full record

SynthesisCanadian journal of anaesthesia = Journal canadien d'anesthesie2019

A systematic review of interventions to facilitate extubation in patients difficult-to-wean due to delirium, agitation, or anxiety and a meta-analysis of the effect of dexmedetomidine.

Sébastien Dupuis, Dave Brindamour, Stephanie Karzon, Anne Julie Frenette, Emmanuel Charbonney, Marc M Perreault, Patrick Bellemare, Lisa Burry, David R Williamson

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Antianxiety effects of dexmedetomidine: systematic review and meta-analysis.European archives of psychiatry and clinical neuroscience · 2026
    Pooled it
  2. Pooled it
  3. Article
  4. Observational
  5. Article
  6. Review
  7. Review
  8. Article
  9. Sedation in the Intensive Care Unit.Current anesthesiology reports · 2021
    Review
  10. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Sébastien Dupuis *Pharmacy Department, Hôpital du Sacré-Cœur-de-Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada.
Dave Brindamour *Pharmacy Department, Hôpital du Sacré-Cœur-de-Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada.
Stephanie KarzonDepartment of Pharmacology, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada.
Anne Julie FrenettePharmacy Department, Hôpital du Sacré-Cœur-de-Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada.
Emmanuel CharbonneyResearch Center, Hôpital du Sacré-Cœur-de-Montréal, Montreal, QC, Canada.
Marc M PerreaultFaculté de Pharmacie, Université de Montréal, Montreal, QC, Canada.
Patrick BellemareDepartment of Critical Care, Hôpital du Sacré-Coeur-de-Montréal, Montreal, QC, Canada.
Lisa BurryPharmacy Department, Mount Sinai Hospital, Toronto, ON, Canada.
David R WilliamsonPharmacy Department, Hôpital du Sacré-Cœur-de-Montréal, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada. david.williamson@umontreal.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDelirium, agitation, and anxiety may hinder weaning from mechanical ventilation and lead to increased morbidity and healthcare costs. The most appropriate clinical approach to weaning in these contexts remains unclear and challenging to clinicians. The objective of this systematic review was to identify effective and safe interventions to wean patients that are difficult-to-wean from mechanical ventilation due to delirium, agitation, or anxiety.

methodsA systematic review was performed using MEDLINE, EMBASE, and PubMed. Studies evaluating mechanically ventilated patients deemed difficult-to-wean due to delirium, agitation, or anxiety, and comparing the effects of an intervention with a comparator arm were sought. Time-to-extubation was the primary outcome while the secondary outcome was intensive care unit (ICU) length of stay.

resultsFrom 10,860 studies identified, eight met the inclusion criteria: six studies assessed dexmedetomidine while the remaining two assessed loxapine and biofeedback. Pooled analysis of studies assessing dexmedetomidine showed reduced time-to-extubation (six studies, n = 303) by 10.9 hr compared with controls (95% confidence interval [CI], -15.7 to -6.1; I

conclusionsThis systematic review and meta-analysis provides low quality evidence to suggest the use of dexmedetomidine in patients deemed difficult-to-wean due to agitation, delirium, or anxiety. Insufficient evidence was found regarding other interventions to provide any recommendation.

trial registrationPROSPERO (CRD42016042528); registered 15 July, 2016.

Indexed as

Airway ExtubationAnxietyDeliriumDexmedetomidineHumansHypnotics and SedativesIntensive Care UnitsPsychomotor AgitationTime FactorsVentilator WeaningDexmedetomidineHypnotics and Sedatives

Identifiers

PMID30674004

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.