Administration of dexmedetomidine in patients with agitated delirium who are on mechanical ventilation appears to reduce time to extubation and resolve delirium. Study results were presented at the International Symposium on Intensive Care and Emergency Medicine.
Delirium, especially agitated delirium, poses an increased risk of adverse outcomes in patients who are receiving mechanical ventilation, as patients are more likely to self-extubate. Prior to this study, no effective therapy had been identified for this patient group.
In order to determine the effectiveness of dexmedetomidine plus standard care in this patient group, Michael C. Reade, DPhil, FCICM, of the University of Queensland in Brisbane, Australia, and colleagues randomized 71 patients to receive either dexmedetomidine plus standard care or just standard care (placebo) for up to 7 days or until no longer needed. In total, 39 patients received dexmedetomidine at an initial rate of 0.5 µg/kg/h and then titrated to rates between 0 and 1.5 µg/kg/h, and 32 patients received standard care.
Overall, dexmedetomidine increased ventilator-free hours at 7 days compared to placebo (median, 144.8 hours vs 127.5 hours, respectively; median difference between groups, 17.0 hours [95% CI, 4.0 to 33.2 hours]; P = .01). Among secondary outcomes, none were significantly worse with dexmedetomidine, and some showed a statistically significant benefit with treatment, including reduced time to extubation (median, 21.9 hours vs 44.3 hours with placebo; median difference between groups, 19.5 hours [95% CI, 5.3 to 31.1 hours]; P < .001) and accelerated resolution of delirium (median, 23.3 hours vs 40.0 hours; median difference between groups, 16.0 hours [95% CI, 3.0 to 28.0 hours]; P = .01).
The authors concluded that the findings support the use of dexmedetomidine in this patient group, citing the possible direct “antidelirium effect” of dexmedetomidine.
Reade MC, Eastwood GM, Bellomo R, et al. Effect of Dexmedetomidine Added to Standard Care on Ventilator-Free Time in Patients With Agitated Delirium: A Randomized Clinical Trial. JAMA. 2016. doi:10.1001/jama.2016.2707.