title: Defining the Role of Dexmedetomidine in the Prevention of Delirium in the Intensive Care Unit.
abstract: Dexmedetomidine is a highly selective α 2 agonist used as a sedative agent. It also provides anxiolysis and sympatholysis without significant respiratory compromise or delirium. We conducted a systematic review to examine whether sedation of patients in the intensive care unit (ICU) with dexmedetomidine was associated with a lower incidence of delirium as compared to other nondexmedetomidine sedation strategies. A search of PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews yielded only three trials from 1966 through April 2015 that met our predefined inclusion criteria and assessed dexmedetomidine and outcomes of delirium as their primary endpoint. The studies varied in regard to population, comparator sedation regimen, delirium outcome measure, and dexmedetomidine dosing. All trials are limited by design issues that limit our ability definitively to conclude that dexmedetomidine prevents delirium. Evidence does suggest that dexmedetomidine may allow for avoidance of deep sedation and use of benzodiazepines, factors both observed to increase the risk for developing delirium. Our assessment of currently published literature highlights the need for ongoing research to better delineate the role of dexmedetomidine for delirium prevention.
authors.affiliation: Critical Care, Hospital Pharmacy Services, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: S
authors.initials: S
authors.lastname: Nelson
authors.affiliation: Department of Pharmacy Practice, Campbell University School of Pharmacy and Health Sciences, Buies Creek, NC 27506, USA ; Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC 27710, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Muzyk
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Medical Center, Knoxville, TN 37920, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Bucklin
authors.affiliation: Departments of Anesthesiology and Medicine, Duke University Medical Center, Durham VAMC, Durham, NC 27710, USA.
authors.forename: S
authors.initials: S
authors.lastname: Brudney
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC 27710, USA ; Department of Medicine, Duke University, Durham, NC 27710, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Gagliardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000706:statistics & numerical data*; D003693:Delirium / Q000453:epidemiology* / Q000517:prevention & control*; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine