Efficacy and safety of analgosedation with dexmedetomidine in critically ill mechanically ventilated children: a systematic review and meta-analysis of randomized controlled trials.

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: We identified 12 trials ( 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.