Safety and adverse events associated with dexmedetomidine for sedation in adult ICU patients: a systematic review and meta-analysis.

Background: Dexmedetomidine (DEX) is increasingly used for sedation in critically ill adults due to its favorable pharmacokinetic profile and potential benefits over traditional sedatives. However, concerns persist regarding its cardiovascular safety. This meta-analysis comprehensively evaluates the incidence and nature of adverse events associated with DEX sedation in adult intensive care unit (ICU) patients. Methods: We conducted a systematic review and meta-analysis according to PRISMA 2020 guidelines. A meta-analysis search of PubMed, Embase, and Cochrane Library was conducted from database inception to June 18, 2025 for randomized controlled trials (RCTs), prospective/retrospective cohort studies, or descriptive studies with a comparator group, reporting safety outcomes in adults receiving DEX for ICU sedation. Primary outcomes were hemodynamic adverse events including hypotension, bradycardia, tachycardia. Data were pooled using fixed-effects models, calculating odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I Results: Ten studies (7 randomized controlled trials, 3 cohorts; total Conclusion: Dexmedetomidine use for ICU sedation is consistently associated with a significantly increased risk of bradycardia. While the overall risk of hypotension was not significantly elevated, specific patient populations may be vulnerable. Tachycardia risk appears modest but highly variable. These findings underscore the necessity for careful patient selection, continuous hemodynamic monitoring particularly heart rate, and cautious titration when using DEX in critically ill adults. Future research should focus on high-risk subgroups and standardize adverse event definitions.