Could remifentanil reduce duration of mechanical ventilation in comparison with other opioids for mechanically ventilated patients? A systematic review and meta-analysis

Yibing Zhu, Yinhua Wang, Bin Du, Xiuming Xi, Yibing Zhu, Yinhua Wang, Bin Du, Xiuming Xi

Abstract

Background: Sedation and analgesia are commonly required to relieve anxiety and pain in mechanically ventilated patients. Fentanyl and morphine are the most frequently used opioids. Remifentanil is a selective μ-opioid receptor that is metabolized by unspecific esterases and eliminated independently of liver or renal function. Remifentanil has a rapid onset and offset and a short context-sensitive half-life regardless of the duration of infusion, which may lead to reductions in weaning and extubation. We aimed to compare the efficacy and safety of remifentanil to that of other opioids in mechanically ventilated patients.

Methods: We conducted a search to identify relevant randomized controlled studies (RCTs) in the PubMed, Embase, Cochrane Library and SinoMed databases that had been published up to 31 December 2016. The results were analysed using weighted mean differences (WMDs) and 95% confidence intervals (CIs).

Results: Twenty-three RCTs with 1905 patients were included. Remifentanil was associated with reductions in the duration of mechanical ventilation (mean difference -1.46; 95% CI -2.44 to -0.49), time to extubation after sedation cessation (mean difference -1.02; 95% CI -1.59 to -0.46), and ICU-LOS (mean difference -0.10; 95% CI -0.16 to -0.03). No significant differences were identified in hospital-LOS (mean difference -0.05; 95% CI -0.25 to 0.15), costs (mean difference -709.71; 95% CI -1590.98 to 171.55; I2 88%), mortality (mean difference -0.64; 95% CI -1.33 to 0.06; I2 87%) or agitation (mean difference -0.71; 95% CI -1.80 to 0.37; I2 93%).

Conclusions: Remifentanil seems to be associated with reductions in the duration of mechanical ventilation, time to extubation after cessation of sedation, and ICU-LOS. No significant differences were identified between remifentanil and other opioids in terms of hospital-LOS, costs, mortality or agitation.

Keywords: Analgesia; Critical care; Mechanical ventilation; Meta-analysis; Remifentanil; Systematic review.

Conflict of interest statement

Ethics approval and consent to participate

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of the process for identification of the included studies
Fig. 2
Fig. 2
Primary outcome. Remifentanil was associated with a reduction in duration of mechanical ventilation
Fig. 3
Fig. 3
Secondary outcomes. Remifentanil was associated with a reduction in time to extubation after cessation (a) and ICU-LOS (b)
Fig. 4
Fig. 4
Funnel plots. Funnel plots were generally asymmetrical. The hollow dots and dotted line indicate individual studies and 95% confidence intervals, respectively. a Funnel plot of duration of mechanical ventilation. b Funnel plot of ICU-LOS. c Funnel plot of time to extubation after cessation of sedation

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