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Sedative may prevent delirium in intensive care patients

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A low dose of the sedative dexmedetomidine given at night may prevent delirium in critically ill patients, according to Canadian researchers.

They said their study was believed to be the first investigation to identify a drug to prevent adults from developing delirium in the intensive care units.

“We believe this is a practice-altering study”

Yoanna Skrobik

The study was led by Dr Yoanna Skrobik, from McGill University, who conducted the first studies of delirium in the critically ill and whose research has shown that delirium prolongs hospital stay and increases mortality.

She said: “In other studies, dexmedetomidine has been associated with lower delirium prevalence rates than other sedatives. But whether dexmedetomidine might actually prevent delirium was not clear.”

The new study enrolled 100 ICU patients at two hospitals, one in Quebec, the other in Boston. The patients did not have delirium at the time of ICU enrollment.

Half the patients were randomly assigned to receive intravenous dexmedetomidine, the other half received a placebo.

The study found that compared to the placebo arm, those receiving dexmedetomidine during their ICU stay were more likely to remain free of delirium throughout their ICU stay – 80% versus 54%.

They also spent more days free of delirium in the ICU – eight versus six days – and were less likely, if in pain, to experience severe pain: 44% versus 66%.

The study authors said they also expected that dexmedetomidine would improve sleep quality, as a previous study of a select group of critically ill patients found that to be the case.

In the current study, however, there was no difference in sleep quality between the two groups, as assessed by a self-reported questionnaire.

There was also no difference in length of ICU stay or hospital stay, or in ICU mortality. But a reduction in opiate requirements confirmed dexmedetomidine’s potential to relieve pain.

“We believe this is a practice-altering study and that dexmedetomidine should be used with patients at high risk for delirium,” said Dr Skrobik.

The findings have been published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

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