Table 1 Characteristics of included studies

Al et al. [11]

Critical Care

2010

205 mechanically ventilated medical and surgical patients; mean age 65; mean SAPS II 45

ICU

37–44%

Remifentanil group: remifentanil 0.4–45ug/kg/h, propofol as rescue treatment once remifentanil infusion > 12 ug/kg/h was needed; control group: analgesia was achieved by either morphine 1–0 mg/h or fentanyl 25–100 mg/h, either propofol 0.5–4 mg/kg/h or midazolam 0.01–0.2 mg/kg/h or lorazepam 0.01–0.1 mg/kg/h for sedation

Remifentanil group: propofol 65%; control group: propofol 46%, midazolam 81%, lorazepam 7%

SAS 3–4

Time to extubation after cessation of sedation, duration of mechanical ventilation, ICU-LOS, costs

Rozendaal et al. [16]

Intensive Critical Medicine

2009

205 mechanically ventilated medical and surgical patients; mean age 65; mean SAPS II 45

ICU

37–44%

Remifentanil group: remifentanil 0.4–45 ug/kg/h, propofol as rescue treatment once remifentanil infusion > 12 ug/kg/h was needed; control group: analgesia was achieved by either morphine 1–10 mg/h or fentanyl 25–-100 mg/h, either propofol 0.5–4 mg/kg/h or midazolam 0.01–0.2 mg/kg/h or lorazepam 0.01–0.1 mg/kg/h for sedation

Remifentanil group: propofol 65%; control group: propofol 46%, midazolam 81%, lorazepam 7%

SAS 3–4

Time to extubation after cessation of sedation, ICU-LOS, duration of mechanical ventilation

Spies et al. [13]

Intensive Critical Medicine

2011

65 adult medical and surgical patients requiring mechanical ventilation for more than 24 h; mean age 63; mean APACHE II 25; mean SOPA 9

ICU

92–97%

Remifentanil group: remifentanil 0.1–0.4 ug/kg/min; fentanyl group: fentanyl 0.02–0.08 ug/kg/min; the study protocol did not allow any bolus application of either fentanyl or remifentanil

Remifentanil group:propofol, midazolam, lorazepam; fentanyl group: propofol, midazolam, lorazepam, proportion not mentioned

VAS ≤ 3 and/or BPS ≤ 6

Duration of mechanical ventilation, ICU-LOS, hospital-LOS, delirium, reflux/vomiting

Lui et al. [20]

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue

2013

60 patients with mechanical ventilation for over 24 h after tumor operation; mean age 64; mean APACHE II 20

ICU

100%

Remifentanil group: remifentanil 0.05 ug/kg/h, titrated up with increment of 0.025 ug/kg/min; fentanyl group: fentanyl 0.5 ug/kg/h, titrated up with increment of 0.25 ug/kg/h; propofol as rescue treatment for remifentanil group once remifentanil infusion > 0.1 ug/kg/h and for fentanyl group once fentanyl infusion > 1 ug/kg/h

Remifentanil group: propofol 26%;fentanyl group: propofol 63%

Ramsay 2–3

Duration of mechanical ventilation, ICU-LOS, costs

Khanykin et al. [36]

The Heart Surgery Forum

2013

71 mechanically ventilated postoperative patients; mean age 64

ICU

100%

Remifentanil group: remifentanil 0.2–0.5 ug/kg/min as required after termination of bypass, remifentanil 0.1–0.2 ug/kg/min for postoperative pain; low-dose fentanyl group: fentanyl 3–4ug/kg as required after termination of bypass, morphine 2.5–5 mg for postoperative pain

None

NR

ICU-LOS, hospital LOS, extubation time

Bhavsar et al. [21]

Anesthesia

2016

60 mechanically ventilated postoperative patients; mean age 68

ICU

100%

Remifentanil group: remifentanil 0.4–0.6 ug/kg/min during surgery, remifentanil 0.1ug/kg/min after surgery; sufentanil group: sufentanil 1–2ug/kg within 1–2 minutes, total dose of sufentanil 3–3.5ug/kg before cardiopulmonary bypass

None

VAS 3–4

Duration of mechanical ventilation, ICU-LOS, hospital-LOS

Engoren et al. [12]

Anesthesia & Analgesia

2001

90 adult patients undergoing cardiac surgery; mean age 60

ICU

100%

Remifentanil group: remifentanil infusion at 0.5–1 ug/kg/min,then maintained 0.05–1 ug/kg/min; fentanyl group: fentanyl 7–10 ug/kg for the induction and additional doses of 1–2 ug/kg as needed for intense stimulus; sufentanil group: sufentanil 1–4 ug/kg for the induction and 0.1–0.3 ug/kg as needed for intense stimulus

None

NR

Duration of mechanical ventilation, ICU-LOS, hospital LOS, costs

Muellejans et al. [22]

Critical Care

2006

80 adult patients undergoing elective cardiac surgery; mean age 66; mean SAPS II 33

ICU

100%

Remifentanil group: remifentanil 6–60 ug/kg/h; fentanyl/midazolam group: fentanyl 1–2 ug/kg/h, midazolam 0.02–0.04 mg/kg/h; propofol as rescue treatment for remifentanil group and midazolam ± fentanil for fentanyl/midazolam group

None

VAS < 4

Delirium, time to extubation after cessation of sedation, duration of mechanical ventilation, ICU-LOS, costs

Muellejans et al. [23]

Critical Care

2004

152 mechanically ventilated medical or surgical patients; mean age 60; mean SAPS II 28

ICU

92–95%

Remifentanil group: remifentanil 9–12 ug/kg/h fentanyl group: fentanyl 1–2 ug/kg/h; propofol as rescue treatment for both groups

Remifentanil group: propofol 35%; fentanyl group: propofol: 40%

SAS 4

Proportion required rescue sedation, nausea/vomiting, time to extubation after cessation of sedation

Karabinis et al. [24]

Critical Care

2004

161 mechanical ventilated elective or emergency neurosurgical patients; mean age 47

neuro-ICU

25–49%

Remifentanil group: remifentanil 9-18 ug/kg/h; fentanyl group: fentanyl 0.1–7.9 ug/kg/min; morphine group: 0-–6.8 mg/kg/min; propofol as rescue treatment for remifentanil group and all patients changed to midazolam infusion on day 3

Remifentanil group: propofol 90%, midazolam 36%; fentanyl group: propofol 100%, midazolam 30%; morphine group: propofol 93%,midazolam 30%

SAS < 4

Mortality, time to extubation after cessation of sedation, duration of mechanical ventilation

Baillard et al. [25]

Annales Françaises d'Anesthésie et de Réanimation

2005

41 mechanically ventilated medical and trauma patients; mean age

ICU

29%

Remifentanil group: remifentanil 10 ug/kg/h and titrated; sufentanil group: sufentanil 0.125 ug/kg/h and titrated; current midazolam for both groups at 0.1 mg/kg/h

Both of remifentanil and sufentanil group: midazolam 100%

Ramsay 4

Mortality, time to extubation after cessation of sedation, ICU-LOS

Dahaba et al. [1]

Anesthesiology

2004

40 mechanically ventilated patients after orthopedic or general surgery; mean age 58; mean SAPS II 23

ICU

100%

Remifentanil group: remifentanil 9–12 ug/kg/h morphine group: morphine 0.04–0.06 mg/kg/h; routine current midazolam 0.03 mg/kg/h for both groups as rescue treatment

Remifentanil group: midazolam 30%; morphine group: 45%

SAS 4

Proportion of patients with agitation, nausea/vomiting, mortality, time to extubation after cessation of sedation, duration of mechanical ventilation, ICU-LOS

Breen et al. [26]

Critical Care

2005

105 mechanically ventilated 3–10days) patients; mean age 54; mean SAPS II 43

ICU

8–13%

Remifentanil group: remifentanil 6–18 ug/kg/h; fentanil or morphine group: standard clinical protocol for the unit; midazolam 2 mg bolus as rescue treatment for both groups

Remifentanil group: midazolam 74%; fentanyl group: midazolam 62%; morphine group: midazolam 23%

SAS 3–4

Nausea/vomiting, mortality, time to extubation after cessation of sedation; duration of mechanical ventilation, ICU-LOS

Belhadj Amor et al. [27]

Annales Françaises d'Anesthésie et de Réanimation

2007

19 mechanically ventilated patients with renal impairment(creatinine clearance < 50 ml/min); mean age 60; mean APACHE II 37

ICU

0

Remifentanil group: remifentanil 6 ug/kg/h, titrated up by increment of 100 ug/h; fentanyl group: fentanyl 1.5 ug/kg/h, titrated up with increment of 25 ug/h; routine concurrent midazolam infusion for both groups at 0.1 mg/kg/h

Remifentanil group: midazolam 78%; fentanyl group: midazolam 95%;

Ramsay 3-4

Proportion of patients with agitation, time to extubation after cessation of sedation, ICU-LOS

Carrer et al. [28]

Minerva Anestesiologica

2007

100 mechanically ventilated postsurgical patients; mean age 69; mean SAPS II 26

ICU

100%

Remifentanil group: remifentanil 6 ug/kg/h and titrated; morphine group: morphine 0.03–0.04 mg/kg/h and titrated; concurrent morphine for both groups at 0.01 mg/kg/h, diazepam 0.1 mg/kg as rescue treatment

Remifentanil group: diazepam 28%; morphine group: diazepam 60%

Ramsay 3

Proportion of patients achieving optimal level of sedation without rescue therapy, nausea/vomiting, duration of mechanical ventilation, ICU-LOS

Gerlach et al. [29]

Journal of Cardiothoracic & Vascular Anesthesia

2002

26 mechanically ventilated postsurgical patients; mean age 64

ICU

100%

Remifentanil group: remifentanil 0.15–0.3 ug/kg/min; sufentanil group: sufentanil 0.5–1 ug/kg/h

Both of remifentanil and sufentanil groups: propofol, proportion not mentioned

Self-reported no pain

Duration of mechanical ventilation, nausea/vomiting, time to extubation after cessation of sedation

Guggenherger et al. [30]

European Journal of Anaesthesiology

2006

59 mechanically ventilated postsurgical patients; mean age 67

ICU

100%

Remifentanil group: remifentanil 0.5–1 ug/kg/min; sufentanil group: 30–40 ng/kg/min

Both of remifentanil and sufentanil groups: propofol, proportion not mentioned

VAS < 4

Duration of mechanical ventilation, hospital-LOS, time to extubation after cessation of sedation, ICU-LOS

Knapik et al. [31]

Medical Science Monitor

2006

40 mechanically ventilated postsurgical patients; mean age 56

ICU

100%

Remifentanil group: remifentanil 0.25–0.5 ug/kg/min; fentanyl group: fentanyl 2.5 ug/kg/h

None

Duration of mechanical ventilation, hospital-LOS

Maddali et al. [32]

Journal of Clinical Anesthesia

2006

180 mechanically ventilated postsurgical patients; mean age 55

ICU

100%

Remifentanil group: remifentanil 1 ug/kg/min; fentanyl group: 0.025–0.15 ug/kg/min; diclofenac group: propofol 2–5 mg/kg/h

Both of remifentanil and fentanyl groups: propofol 100%

VAS < 4

Duration of mechanical ventilation, time to extubation after cessation of sedation, ICU-LOS

Myles et al. [19]

Anesthesia and Analgesia

2002

87 mechanically ventilated postsurgical patients; mean age 62

ICU

100%

Remifentanil group: remifentanil 0.83 ug/kg/min; small dose fentanyl group: fentanyl bolus, small dose, at 12 ug/kg; moderate dose fentanyl group: fentanyl bolus, moderate dose, at 24 ug/kg

All of remifentanil, small dose fentanyl and moderate dose fentanyl groups: propofol 100%

NR

Duration of mechanical ventilation, hospital-LOS, costs

Winterhalter et al. [33]

European Journal of Anaesthesiology

2008

42 mechanically ventilated postsurgical adult patients; mean age 63

ICU

100%

Remifentanil group: remifentanil 0.25 ug/kg/min; fentanyl group: fentanyl bolus 4 ug/kg every 30 min

Both of remifentanil and fentanyl groups: propofol 100%

VAS < 4

Duration of mechanical ventilation, hospital-LOS, time to extubation after cessation of sedation

Bedirli et al. [34]

Journal of Anesthesia

2007

50 mechanically ventilated postsurgical patients; mean age 61

ICU

100%

Remifentanil group: remifentanil 1ug/kg/min; fentanyl group: fentanyl 5 ug/kg/h

None

NR

Hospital-LOS;ICU-LOS

Chinachoti et al. [35]

Medical Association of Thailand

2002

152 mechanically ventilated patients with normal renal function or mild renal impairment; mean age 59; mean SAPS II 26

ICU

NR

Remifentanil group: 9–60 ug/kg/h; morphine group:0.045–0.3 mg/kg/h

Both of remifentanil and morphine groups: midazolam

SAS 4

Time to extubation after cessation of sedation, duration of mechanical ventilation