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Review Article
Online Published: 22 Nov 2025
 


Optimizing sedation strategies in ICU patients: a network meta-analysis of clinical outcomes

Hosam Hadi Awaji, Abdullah Abdulrahman A Alharbi, Lama Mana Alamri, Ahmed Abdulrahman Alqahtani, Rama Mathel Alanazi, Haya Mohammed Alsubaie, Areej Reja Alrashedi, Lama Zaid Alzimami, Hamoud Abdulkarim Almarshadi, Jumanah Abdullah Aljehani.


Abstract
Although sedation is a fundamental component of intensive care unit (ICU) management, the most effective approach remains ambiguous. The objective of this network meta-analysis (NMA) was to assess and contrast the efficacy of a variety of sedation protocols in adult ICU patients with respect to postoperative delirium (POD), ventilator-free days (VFDs), ICU length of stay (LOS), and mortality. The study included sixteen randomized controlled trials (RCTs) that involved 3,783 patients. Random-effects models were implemented to conduct Bayesian network meta-analyses. Dexmedetomidine was the most effective treatment for POD, substantially reducing delirium in comparison to midazolam and ranking first in 61.7% of simulations. In a distinct network, the most effective method for reducing POD was daily sedation interruption (DIS). However, isoflurane was the most effective in terms of VFDs, despite the absence of statistical significance. Lorazepam demonstrated the lowest performance (70.1% worst rank). In the second network, protocols that did not require sedation were the most effective in optimizing VFDs, with a top rank of 70.1%. Lorazepam was significantly associated with increased mortality, whereas mild sedation and no sedation were ranked most favorably in the alternative network model. Inhaled isoflurane and dexmedetomidine are among the most efficacious agents for reducing POD and increasing ventilator-free days, respectively. There is a correlation between reduced ICU LOS and mortality, and light sedation and no-sedation strategies. In contrast, lorazepam and midazolam were consistently linked to worse outcomes. These results advocated for the prioritization of mild, individualized sedation strategies in ICU care.

Key words: Sedation protocols, ICU, delirium, mortality, ventilator-free days, network meta-analysis


 
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How to Cite this Article
Pubmed Style

Awaji HH, Alharbi AAA, Alamri LM, Alqahtani AA, Alanazi RM, Alsubaie HM, Alrashedi AR, Alzimami LZ, Almarshadi HA, Aljehani JA. Optimizing sedation strategies in ICU patients: a network meta-analysis of clinical outcomes. IJMDC. 2025; 9(10): 2584-2596. doi:10.24911/IJMDC.51-1761678155

Web Style

Awaji HH, Alharbi AAA, Alamri LM, Alqahtani AA, Alanazi RM, Alsubaie HM, Alrashedi AR, Alzimami LZ, Almarshadi HA, Aljehani JA. Optimizing sedation strategies in ICU patients: a network meta-analysis of clinical outcomes. https://www.ijmdc.com/?mno=293261 [Access: December 09, 2025]. doi:10.24911/IJMDC.51-1761678155

AMA (American Medical Association) Style

Awaji HH, Alharbi AAA, Alamri LM, Alqahtani AA, Alanazi RM, Alsubaie HM, Alrashedi AR, Alzimami LZ, Almarshadi HA, Aljehani JA. Optimizing sedation strategies in ICU patients: a network meta-analysis of clinical outcomes. IJMDC. 2025; 9(10): 2584-2596. doi:10.24911/IJMDC.51-1761678155


Vancouver/ICMJE Style

Awaji HH, Alharbi AAA, Alamri LM, Alqahtani AA, Alanazi RM, Alsubaie HM, Alrashedi AR, Alzimami LZ, Almarshadi HA, Aljehani JA. Optimizing sedation strategies in ICU patients: a network meta-analysis of clinical outcomes. IJMDC. (2025), [cited December 09, 2025]; 9(10): 2584-2596. doi:10.24911/IJMDC.51-1761678155


Harvard Style

Awaji, H. H., Alharbi, . A. A. A., Alamri, . L. M., Alqahtani, . A. A., Alanazi, . R. M., Alsubaie, . H. M., Alrashedi, . A. R., Alzimami, . L. Z., Almarshadi, . H. A. & Aljehani, . J. A. (2025) Optimizing sedation strategies in ICU patients: a network meta-analysis of clinical outcomes. IJMDC, 9 (10), 2584-2596. doi:10.24911/IJMDC.51-1761678155


Turabian Style

Awaji, Hosam Hadi, Abdullah Abdulrahman A Alharbi, Lama Mana Alamri, Ahmed Abdulrahman Alqahtani, Rama Mathel Alanazi, Haya Mohammed Alsubaie, Areej Reja Alrashedi, Lama Zaid Alzimami, Hamoud Abdulkarim Almarshadi, and Jumanah Abdullah Aljehani. 2025. Optimizing sedation strategies in ICU patients: a network meta-analysis of clinical outcomes. International Journal of Medicine in Developing Countries, 9 (10), 2584-2596. doi:10.24911/IJMDC.51-1761678155


Chicago Style

Awaji, Hosam Hadi, Abdullah Abdulrahman A Alharbi, Lama Mana Alamri, Ahmed Abdulrahman Alqahtani, Rama Mathel Alanazi, Haya Mohammed Alsubaie, Areej Reja Alrashedi, Lama Zaid Alzimami, Hamoud Abdulkarim Almarshadi, and Jumanah Abdullah Aljehani. "Optimizing sedation strategies in ICU patients: a network meta-analysis of clinical outcomes." International Journal of Medicine in Developing Countries 9 (2025), 2584-2596. doi:10.24911/IJMDC.51-1761678155


MLA (The Modern Language Association) Style

Awaji, Hosam Hadi, Abdullah Abdulrahman A Alharbi, Lama Mana Alamri, Ahmed Abdulrahman Alqahtani, Rama Mathel Alanazi, Haya Mohammed Alsubaie, Areej Reja Alrashedi, Lama Zaid Alzimami, Hamoud Abdulkarim Almarshadi, and Jumanah Abdullah Aljehani. "Optimizing sedation strategies in ICU patients: a network meta-analysis of clinical outcomes." International Journal of Medicine in Developing Countries 9.10 (2025), 2584-2596. Print. doi:10.24911/IJMDC.51-1761678155


APA (American Psychological Association) Style

Awaji, H. H., Alharbi, . A. A. A., Alamri, . L. M., Alqahtani, . A. A., Alanazi, . R. M., Alsubaie, . H. M., Alrashedi, . A. R., Alzimami, . L. Z., Almarshadi, . H. A. & Aljehani, . J. A. (2025) Optimizing sedation strategies in ICU patients: a network meta-analysis of clinical outcomes. International Journal of Medicine in Developing Countries, 9 (10), 2584-2596. doi:10.24911/IJMDC.51-1761678155




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