• Shuguang Yang, Huiying Zhao, Huixia Wang, Hua Zhang, and Youzhong An.
• Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China.
• Medicine (Baltimore). 2021 Sep 24; 100 (38): e27275e27275.

Background And AimsTo identify the efficacy and safety of remifentanil when compared with other opioids in adult critically ill patients.MethodsWe searched for studies in the Cochrane Library, MEDLINE, and EMBASE that had been published up to May 31st, 2019. Randomized clinical trials using remifentanil comparing with other opioids for analgesia were included. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. Duration of mechanical ventilation was the primary outcome, and secondary outcomes included weaning time, intensive care unit (ICU), length of stay (LOS), hospital LOS, mortality, side effects, and costs.ResultsFifteen studies with 1233 patients were included. Remifentanil was associated with a significant reduction in the duration of mechanical ventilation in the adult ICU patients when compared with other opioids (P = .01). Remifentanil also reduced the weaning time (P = .02) and the ICU LOS when compared with other opioids (P = .01). There was no difference in the hospital LOS (P = .15), side effects (P = .39), and mortality (P = .79) between remifentanil and other opioids, what's more, remifentanil increased the costs of anesthesia (P < .001) but did not increase cost of hospitalization (P = .30) when comparing with other opioids.ConclusionsRemifentanil reduced the duration of mechanical ventilation, weaning time, and ICU LOS when compared with other opioids in adult critically ill patients. Higher quality RCTs are necessary to prove our findings.Prospero Registration NumberCRD42016041438.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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