Dexmedetomidine in Traumatic Brain Injury: A Meta-Analysis of Functional Gains and Neuroprotective Potential

Background and/or Objectives: The objective of this study is to evaluate whether dexmedetomidine improves functional outcomes in traumatic brain injury (TBI) patients compared to conventional sedatives.

Design: Systematic review and meta-analysis following PRISMA 2020 guidelines (PROSPERO: CRD42025629712).

Setting : Intensive care units from 6 studies across 5 countries.

Participants : 44 patients with moderate-to-severe TBI (mean age 42.3 years; 68% male).

Interventions: Dexmedetomidine (0.2-1.5 μg/kg/hr) versus propofol (4 studies), benzodiazepines (1 study), or placebo (1 study).

Main Outcome Measures: Glasgow Outcome Scale (GOS) or Extended (GOS-E) at 3-6 months post-injury.

Results: Analysis of 6 studies (3 randomized controlled trials, 3 observational cohorts) demonstrated a small-to-moderate treatment effect favoring dexmedetomidine (Cohen’s d = 0.44; 95% CI: 0.19-0.69; p< 0.001), equivalent to a 1.5-point improvement on GOS-E. Moderate heterogeneity (I²=62.4%) was attributed to variable dosing protocols and outcome timing. GRADE analysis indicated very low certainty of evidence due to moderate bias risk and small sample sizes.

Conclusions: Dexmedetomidine shows clinically meaningful functional improvements in TBI patients, with effect sizes comparable to early neurorehabilitation interventions. These findings support its potential role in bridging acute neuroprotection through reduced neuroinflammation and long-term recovery via preserved cognitive capacity. Multicenter trials using standardized GOS-E assessments at 6 months are needed to confirm optimal clinical utility.