Objective  Systematic evaluation of the efficacy of dexmedetomidine for mechanical ventilation in acute respiratory distress syndrome (ARDS).

Methods  PubMed, Embase, Cochrane Library and CNKI were searched from the time of inception to June 25, 2025. Two researchers independently performed literature screening, data extraction, and quality assessment according to predefined inclusion and exclusion criteria. Meta-analysis was conducted using Stata 12.0 software.

Results  A total of 9 randomized controlled trials were included.  The results showed that dexmedetomidine alone or in combination with other drugs significantly reduced the level of  inflammatory factors IL-6 [WMD=-1.13, 95%CI (-1.92, -0.35)] and TNF-α [WMD=-0.87, 95%CI (-1.34, -0.4)], improved oxygenation index [WMD=1.83, 95%CI (0.64, 3.03)], shortened ICU length of stay [WMD=-1.44, 95%CI (-1.76, -1.12)] and mechanical ventilation duration [WMD=-0.93, 95%CI (-1.26, -0.95)], the differences were statistically significant (P<0.05). However, there was no significant difference in MAP levels [WMD=0.39, 95%CI (-0.20, 0.98)].

Conclusion  In mechanically ventilated ARDS patients, dexmedetomidine reduces acute stress-induced inflammation, improves oxygenation index, shortens ICU stay, decrease mechanical ventilation duration. These findings provide clinical evidence supporting the use of dexmedetomidine in ARDS patients undergoing mechanical ventilation.

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