The effect of dexmedetomidine on clinical and management outcomes in patients with septic shock: A systematic review and meta-analysis of randomized trials.

BACKGROUND

Septic shock constitutes a significant health concern, resulting in substantial morbidity and mortality. Dexmedetomidine (DEX) was reported to significantly mitigate vasopressor resistance in septic shock, enhancing clinical outcomes. We aim to investigate DEX effect on mortality, clinical, and management outcomes in septic shock patients.

METHODS

Systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus, and Web of Science until January 2025 without language restrictions. Using Stata MP v. 17, fixed-effects model used to report dichotomous outcomes and continuous outcomes using relative risk (RR) and mean difference (MD), respectively, with a 95 % confidence interval (CI).

PROSPERO ID: CRD42025641437.

RESULTS

Eight RCTs and 662 patients were included. There was no significant difference between DEX and usual care for the primary outcome of in-hospital mortality (RR: 0.78, 95 % CI [0.56, 1.11], p = 0.17). Similarly, no significant differences were found for secondary outcomes of ICU mortality (RR: 0.73, 95 % CI [0.48, 1.13], p = 0.16), and long-term mortality (RR: 0.90, 95 % CI [0.73, 1.11], p = 0.33). No significant difference between both groups regarding the ICU length of stay (LOS) (MD: 0.07, 95 % CI [-0.97, 1.12], p = 0.89), mechanical ventilation duration (MD: 0.29, 95 % CI [-0.26, 0.84], p = 0.30), and vasopressor infusion duration (MD: -0.32, 95 % CI [-0.79, 0.15], p = 0.18). However, DEX significantly increased hospital LOS (MD: 1.12, 95 % CI [0.19, 2.04], p = 0.02).

CONCLUSION

With low certainty of evidence, DEX did not significantly impact mortality, ICU LOS, mechanical ventilation duration, vasopressor infusion duration, acute kidney injury, bradycardia, hypotension, and delirium. Still, DEX significantly increased hospital LOS.