Dexmedetomidine for acute respiratory conditions requiring non-invasive respiratory support in pediatric and adult patients: systematic review and meta-analysis of the literature

Background Dexmedetomidine is increasingly used as an anxiolytic and sedative in pediatric patients with acute respiratory distress for managing anxiety and agitation. However, its effectiveness and safety in the pediatric population remain unclear, and clinical practice is often guided by evidence derived from adults. Aim A systematic review was conducted to examine the evidence on the use of dexmedetomidine in patients undergoing non-invasive respiratory support (NRS) for acute respiratory conditions in both pediatric and adult individuals. Methods A comprehensive literature search was conducted on PubMed, Web of Science and Embase up to September 2025, evaluating dexmedetomidine in patients requiring NRS. The risk of bias was assessed using JBI’s critical appraisal tools, and available comparative studies randomized controlled studies (RCT) were analyzed in a meta-analysis. Certainty was graded according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. Results Ten studies evaluating dexmedetomidine in pediatric NRS were identified. While most studies suggested that dexmedetomidine may improve tolerance to NRS and reduce agitation, the pediatric evidence base consists mainly of observational studies without randomized trials, preventing a quantitative synthesis. Consequently, any direct comparisons with adult results cannot be directly extrapolated and should be considered strictly exploratory. Twenty-four studies (9 RCTs) were conducted in adult patients. The evidence from adult studies was more robust, showing that dexmedetomidine has the potential to reduce agitation, aid NRS acceptance, and decrease the need for intubation, as well as the incidence of delirium. Conclusion Current evidence supporting the use of dexmedetomidine in pediatric patients undergoing NRS is promising but remains insufficient. Findings from adult populations suggest that dexmedetomidine can effectively reduce agitation and may facilitate NRS acceptance in various conditions requiring respiratory support. However, future robust randomized controlled trials in pediatric patients are needed to determine efficacy, optimal dosing and safety in children with acute respiratory distress. These data will enable the development of age-specific guidelines and recommendations, ensuring a safer and more effective use.