Association between the use of midazolam, fentanyl, propofol, ketamine, and dexmedetomidine and the incidence of delirium in elderly patients in intensive care units: a systematic review

Santos W.S.; Carrión-Torres O.; Mussalem M.G.V.B.; Baptista V.S.; Yarak S. · Sao Paulo Medical Journal (2025) · DOI: 10.1590/1516-3180.2024.0311r1.14072025

Resumen

BACKGROUND: Delirium is a common and serious complication among elderly patients in intensive care units (ICUs), and is often associated with increased morbidity and mortality rates. The choice of sedoanal-gesic may influence the incidence of delirium; however, the evidence remains unclear, particularly in the elderly population. OBJECTIVES: To evaluate the association between the use of different sedoanalgesics and the incidence of delirium in elderly ICU patients, based on data from randomized clinical trials. DESIGN AND SETTING: This systematic review was conducted using data from randomized clinical trials performed in various ICU settings. METHODS: A systematic search of the MEDLINE, Embase, and CENTRAL databases was performed in Jan-uary 2024. The review included randomized clinical trials involving patients aged 60 years or older that examined the relationship between sedoanalgesics (midazolam, fentanyl, propofol, ketamine, and dex-medetomidine) and delirium incidence. Studies involving COVID-19 patients and non-randomized studies were excluded. RESULTS: A total of 1,331 patients from six studies were included. The mean age of the patients ranged from 71 to 74.7 years. Four studies compared dexmedetomidine with propofol; two found no significant difference in delirium incidence, whereas two suggested a lower incidence with dexmedetomidine. The remaining studies compared propofol with ketamine and dexmedetomidine with midazolam and showed no significant differences in the incidence of delirium. CONCLUSIONS: Dexmedetomidine may be associated with a lower incidence of delirium than propofol or midazolam in elderly ICU patients. However, further research is needed to confirm these findings and explore the factors contributing to delirium in this population. SYSTEMATIC REVIEW REGISTRATION: Registered with PROSPERO, CRD42024575693, available at https:// www.crd.york.ac.uk/prospero/display_record.php?RecordID=575693.

Instituciones: Universidad Peruana de Ciencias Aplicadas