Meta-analysis of remimazolam versus propofol in mechanically ventilated ICU patients

BACKGROUND AND AIM: The management of sedation in mechanically ventilated intensive care unit (ICU) patients is very challenging in critical care medicine. Remimazolam and propofol are used as sedative agents for ICU patients undergoing mechanical ventilation. This meta-analysis evaluates the efficacy and safety of remimazolam compared to propofol in mechanically ventilated ICU patients. METHODS: We conducted a comprehensive database search up to April 2025, included the studies that met our inclusion criteria. We evaluated mortality rates and other secondary outcomes to compare the efficacy of remimazolam and propofol. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using RevMan software. RESULTS: Three RCTs were selected from a total of 745 retrieved articles, including 220 patients undergoing IMV in an ICU setting. The findings revealed no statistically significant difference in mortality rates (OR 0.54; 95% CI: 0.26 to 1.12; p = 0.10) or 28-day survival rates (OR 1.59; 95% CI: 0.81 to 3.12; p = 0.18), and the mean difference in ICU duration of stay was -1.50 days (95% CI: -5.01 to 2.02; p = 0.40) between the two sedatives. Remimazolam demonstrated a significant reduction in total adverse events (OR 0.38; 95% CI: 0.20 to 0.72; p = 0.00) and the occurrence of delirium (OR 0.36; 95% CI: 0.16 to 0.83; p = 0.02), with no observed heterogeneity (I = 0%). CONCLUSION: This meta-analysis shows that remimazolam provides comparable efficacy to propofol regarding mortality and survival, with significant advantages in reducing adverse events and delirium.