Dexmedetomidine versus usual care in adult patients with septic shock receiving vasopressors

BACKGROUND Septic shock is characterised by sepsis-induced hypotension refractory to fluid resuscitation efforts. Further treatment often requires mechanical ventilation, typically requiring the use of sedatives to provide analgesia, sedation and anxiolysis. One sedative, dexmedetomidine, is an α2 agonist that has demonstrated potential in improving haemodynamic and clinical outcomes in recent randomised controlled trials. However, support for these claims has been inconsistent across individual studies. OBJECTIVE This meta-analysis aimed to assess the efficacy of dexmedetomidine in comparison to other sedatives. DESIGN Systematic review of randomised controlled trials with meta-analyses. DATA SOURCES The search was performed across five electronic databases (Embase, PubMed, Scopus, MEDLINE and clinicaltrials.gov) from inception up to June 2025. ELIGIBILITY CRITERIA We included randomised controlled studies that utilised adult patients diagnosed with septic shock and receiving sedation with dexmedetomidine or any other. Excluded types of studies included non-RCTs, animal studies, paediatric cases, procedural sedation, trials without reported outcomes and studies that do not report desired outcomes. RESULTS Our meta-analysis included eight randomised controlled trials ( n = 702 patients), which revealed that dexmedetomidine significantly decreased the day-2 Sequential Organ Failure Assessment (SOFA) score ( P = 0.009) and the incidence of acute kidney injury (AKI) ( P = 0.004). Importantly, dexmedetomidine significantly increased the duration of hospital stay ( P = 0.01) and the incidence of hypotension ( P = 0.04). There were non-significant decreases in 28-day mortality ( P = 0.08), duration of mechanical ventilation ( P = 0.28), duration of intensive care unit (ICU) stay ( P = 0.74), delirium incidence ( P = 0.60), bradycardia incidence ( P = 0.14), 24-h serum IL-6 levels ( P = 0.18), 24-h serum CRP levels ( P = 0.44) and 24-h serum lactate levels ( P = 0.93). CONCLUSION Dexmedetomidine may improve early organ dysfunction; however, evidence for long-term clinical benefits remains limited.