Sedative Lowers ICU Delirium Risk

Administration of low-dose dexmedetomidine at night is associated with reduced incidence of delirium among hospitalized, critically ill adults in the intensive care unit (ICU), according to findings from a new study.

During the study, researchers evaluated the effects of nocturnal administration of intravenous dexmedetomidine among 100 critically ill adults without delirium who received sedatives.
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Fifty patients were treated with 0.2 mcg/kg/min, titrated by 0.1 mcg/kg/min every 15 minutes until a goal RASS of -1 or a maximum rate of 0.7 mcg/kg/min was reached. All sedatives were halved and opioids were unchanged during study infusions. The remaining 50 patients received placebo.

The Intensive Care Delirium Screening Checklist and the Leeds Sleep Evaluation Questionnaire (LSEQ) were used to assess delirium and sleep, respectively, in each group.

Findings indicated that nocturnal treatment with dexmedetomidine was associated with reduced odds of delirium during the ICU stay compared with placebo (40 [80%) vs 27 [54%] delirium-free patients).

Patients in both groups with at least 1 available LSEQ assessment had similar LSEQ scores, and the between-group incidence of hypotension, bradycardia, or both was also similar.

“Nocturnal administration of low-dose dexmedetomidine in critically ill adults reduces the incidence of delirium during the ICU stay; patient-reported sleep quality appears unchanged,” the researchers concluded.

—Christina Vogt

Reference:

Skrobik Y, Duprey MS, Hill NS, Devlin JW. Low-dose nocturnal dexmedetomidine prevents ICU delirium: a randomized, placebo-controlled trial [Published online March 2018]. Am J Respir Crit Care Med. http://www.thoracic.org/about/newsroom/press-releases/resources/drug-prevents-icu-delirium.pdf.