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SYSTEMATIC REVIEW article

Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1370481

ICU patients receiving remifentanil do not experience reduced duration of mechanical ventilation: a systematic review of randomized controlled trials and network meta-analyses based on Bayesian theories

Provisionally accepted
Li Cong Li Cong 1*Dai Zhaoqiu Dai Zhaoqiu 2Chen Xunxun Chen Xunxun 3Fangjie Lu Fangjie Lu 4Qin Sirun Qin Sirun 5Liu Chang Liu Chang 6
  • 1 Emergency Center, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
  • 2 Changshu Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Suzhou, Liaoning Province, China
  • 3 Center for Tuberculosis Control of Guangdong Province, Guangzhou, Guangdong, China
  • 4 Department of Critical Care Medicine, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
  • 5 Department of Cardiovascular Medicine, Third Xiangya Hospital, Central South University, Changsha, Anhui Province, China
  • 6 Department of Emergency Center, Affiliated Huai’an Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China

The final, formatted version of the article will be published soon.

    The purpose of this network meta-analysis (NMA) was to evaluate the efficacy of intravenous opioid μ-receptor analgesics on shortening the duration of mechanical ventilation (MV) in ICU patients.Methods: Randomized controlled trials comparing the efficacy of remifentanil, sufentanil, morphine, and fentanyl on the duration of MV in ICU patients were searched in Embase, Cochrane, Pubmed, and Web of Science four electronic databases. The primary outcome was MV duration. The Bayesian random-effects framework was used to evaluate relative efficacy.Results: Twenty studies were included in this NMA involving 3442 patients.Remifentanil was not associated with a reduction in the duration of MV compared with fentanyl (mean difference (MD) -0.16; 95% Credible interval (CrI): -4.75~5.63) and morphine (MD 3.84; 95% CrI: -0.29~10.68). The secondary outcomes showed that, compared with remifentanil, sufentanil can prolonged the duration of extubation. No regimen significantly shortened the ICU length of stay and improved the ICU mortality, efficacy, safety, and drug-related adverse events.Conclusions: Among these analgesics, remifentanil did not appear to be associated with a reduction in MV duration. Clinicians should carefully titrate the analgesia of MV patients to prevent a potentially prolonged duration of MV due to excessive or inadequate analgesic therapy.

    Keywords: Critical Illness, mechanical ventilation, analgesis, opioid, remifentanil, Network meta-analysis

    Received: 28 Jan 2024; Accepted: 24 Jul 2024.

    Copyright: © 2024 Cong, Zhaoqiu, Xunxun, Lu, Sirun and Chang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Li Cong, Emergency Center, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.