Mortality-associated meta-analysis of dexmedetomidine in septic shock
Hong Zhou, Juan Cui, Shufang Wang, Weiwei Zhao, Chang Meng, Guobin MiaoBackground:
Septic shock is a severe subtype of sepsis associated with poor clinical outcomes, representing a major challenge in critical care medicine. Sedation management is a core component of comprehensive treatment for patients with septic shock. Dexmedetomidine, a highly selective α2-adrenergic receptor agonist, has shown potential prognostic benefits in the general sepsis population, but its efficacy and mortality impact in septic shock patients remain controversial and lack targeted systematic evaluation.
Methods:
This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases for studies published up to October 1, 2025, and included randomized controlled trials (RCTs). We quantitatively analyzed key outcomes (intensive care unit [ICU] mortality, 28-day mortality, length of ICU stay), and assessed the methodological quality of included RCTs with the Risk of Bias 2.0 tool (RoB 2.0).
Results:
This study is registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) with the number INPLASY202510103. A total of 11 moderate-to-high quality RCTs involving 836 patients were included. Compared with controls (conventional treatment, propofol, or midazolam), dexmedetomidine showed no statistically significant benefits in ICU mortality (odds ratio: 0.72, 95% confidence interval [CI]: 0.46–1.12;
Conclusion:
Dexmedetomidine shows no statistically significant benefits in reducing 28-day mortality or shortening ICU stay in patients with septic shock, despite its preclinical anti-inflammatory and organ-protective effects. This differs from findings in broader sepsis populations, highlighting the need for severity stratification and targeted research.