Efficacy of ciprofol versus propofol for sedation in mechanically ventilated intensive care unit patients: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND

Ciprofol, a novel sedative-hypnotic agent and structural analog of propofol, has emerged as a promising sedative agent in recent years. However, its efficacy in mechanically ventilated intensive care unit (ICU) patients is not well understood.

AIMS: To compile and synthesise the existing evidence on the efficacy and safety of ciprofol compared to propofol in mechanically ventilated ICU patients.

METHODS

We systematically searched PubMed, Scopus, Web of Science and CNKI databases from inception to June 2025 for randomised controlled trials (RCTs) comparing ciprofol and propofol in ICU settings. Outcomes analysed included sedation success, hypotension, time to extubation, rescue sedation and bradycardia. Meta-analysis was then conducted to quantitatively assess and compare these outcomes between ciprofol and propofol.

RESULTS

Three RCTs, comprising 228 participants, were included. There was no significant difference in sedation success between ciprofol and propofol (risk ratio (RR) = 0.989, 95% confidence interval (CI) = 0.809-1.209; P = 0.913), indicating that ciprofol is as efficient as propofol (the gold standard in this area) in inducing sedation. Ciprofol was associated with a lower risk of hypotension, although this association did not reach statistical significance (RR = 0.668, 95% CI = 0.397-1.124; P = 0.128). Similarly, the mean difference in time to extubation was not significant (MD = -2.98 min, 95% CI = -6.80 to 0.83; P = 0.125). Rescue sedation rates also did not differ significantly (RR = 0.786, 95% CI = 0.163-3.800; P = 0.764), and no significant difference was found in the risk of bradycardia (RR = 0.874, 95% CI = 0.298-2.558; P = 0.805). Across all outcomes, heterogeneity was negligible (I2 = 0.0%).

CONCLUSIONS

Ciprofol demonstrates comparable efficacy and safety to propofol for ICU sedation in mechanically ventilated adults. Further large-scale RCTs are needed to confirm these findings.