Dexmedetomidine for Delirium Prevention in Non-Mechanically Ventilated ICU Patients

Abstract

Introduction: Dexmedetomidine reduces delirium in mechanically ventilated ICU patients, but evidence in non-ventilated patients is sparse. This review focuses on its efficacy and safety in awake ICU patients.
Methods: Literature search (2015–2024) for RCTs and retrospective studies of dexmedetomidine infusion vs. placebo or other sedatives (benzodiazepines, propofol) in non-intubated adult ICU patients. Primary outcome: delirium incidence (CAM-ICU). Secondary: bradycardia and hypotension.
Results: Seven studies (n=1,442) showed dexmedetomidine reduced delirium incidence (risk ratio 0.65, p=0.003) compared to benzodiazepines, but not compared to propofol or placebo. Bradycardia occurred in 12% (vs. 4% placebo), hypotension in 15% (vs. 10%). Dexmedetomidine improved sleep quality (actigraphy).
Discussion: Dexmedetomidine’s anti-delirium effect in non-ventilated patients is modest and mainly against benzodiazepines. Its sleep-promoting and anti-inflammatory properties may help, but hemodynamic monitoring is required.
Conclusions: Dexmedetomidine may be considered for delirium prevention in non-ventilated ICU patients at high risk, particularly those receiving benzodiazepines. Routine use not supported versus propofol.