Role of dexmedetomidine in the treatment of delirium in critically ill patients: a systematic review and meta-analysis

Liu, Xu; Xiong, Jie; Tang, Yan; Gong, Chenchen; Wang, Difen

doi:10.23736/s0375-9393.20.14492-4

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…In terms of treating delirium, the mainstay of delirium treatment is treatment of the underlying cause, complimented by prevention of complications (such as falls, pressure injuries). 7 Other interventions, for example, non-pharmacological multicomponent strategies, 7 33 or dexmedetomidine in the ICU setting, 36 have shown limited benefit in terms of reducing the duration or severity of delirium. 7 33 36 There is some evidence that specialist aged care teams may have benefit in the care of older surgical patients, including those presenting with trauma.…”

Section: Open Accessmentioning

confidence: 99%

Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

Chróinín

Francis

Wong

et al. 2021

Trauma Surg Acute Care Open

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BackgroundGiven the increasing numbers of older patients presenting with trauma, and the potential influence of delirium on outcomes, we sought to investigate the proportion of such patients who were diagnosed with delirium during their stay—and patient factors associated therewith—and the potential associations between delirium and hospital length of stay (LOS). We hypothesized that delirium would be common, associated with certain patient characteristics, and associated with long hospital LOS (highest quartile).MethodsWe conducted a retrospective observational cohort study of all trauma patients aged ≥65 years presenting in September to October 2019, interrogating medical records and the institutional trauma database. The primary outcome measure was occurrence of delirium.ResultsAmong 99 eligible patients, delirium was common, documented in 23% (23 of 99). On multivariable analysis, adjusting for age, frailty and history of dementia, frailty (OR 4.09, 95% CI 1.08 to 15.53, p=0.04) and dementia (OR 5.23, 95% CI 1.38 to 19.90, p=0.02) were independently associated with likelihood of delirium. Standardized assessment tools were underused, with only 34% (34 of 99) screened within 4 hours of arrival. On univariate logistic regression analysis, having an episode of delirium was associated with long LOS (highest quartile), OR of 5.29 (95% CI 1.92 to 14.56, p<0.001). In the final multivariable model, adjusting for any (non-delirium) in-hospital complication, delirium was independently associated with long LOS (≥16 days; OR 4.81, p=0.005).DiscussionIn this study, delirium was common. History of dementia and baseline frailty were associated with increased risk. Delirium was independently associated with long LOS. However, many patients did not undergo standardized screening at admission. Early identification and targeted management of older patients at risk of delirium may reduce incidence and improve care of this vulnerable cohort. These data are hypothesis generating, but support the need for initiatives which improve delirium care, acknowledging the complex interplay between frailty and other geriatric syndromes in the older trauma patients.Level of evidenceIII.

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Section: Open Accessmentioning

confidence: 99%

Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

Chróinín

Francis

Wong

et al. 2021

Trauma Surg Acute Care Open

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“…In this trial, the sample size is the number of participants who develop hyperactive delirium and receive an investigational drug according to the study protocol, because the primary outcome is the proportion of participants who achieve the targeted sedation level at 2 hours after the start of administering the investigational drug. A previous meta-analysis showed that approximately 90% of hyperactive delirium patients were successfully treated with dexmedetomidine [ 18 ], although the patients who were included in the meta-analysis were not limited to non-intubated patients. In contrast, approximately 65% of non-intubated patients with hyperactive delirium were adequately treated with haloperidol [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…In contrast, approximately 65% of non-intubated patients with hyperactive delirium were adequately treated with haloperidol [ 15 ]. However, the participants in the above meta-analysis were possibly treated with other sedatives because the original studies included mechanically-ventilated patients [ 18 ], and the dose of haloperidol in that study was higher than that in our trial [ 15 ]. Therefore, in our protocol using a lone investigational drug, we underestimated the efficacy of dexmedetomidine or haloperidol by approximately 5%; we used the estimated efficacy in the dexmedetomidine and haloperidol groups of 85% and 60%, respectively, to calculate the sample size.…”

Section: Methodsmentioning

confidence: 99%

Dexmedetomidine versus haloperidol for sedation of non-intubated patients with hyperactive delirium during the night in a high dependency unit: study protocol for an open-label, parallel-group, randomized controlled trial (DEX-HD trial)

et al. 2023

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Background Delirium is common in critically ill patients. Haloperidol has long been used for the treatment of delirium. Dexmedetomidine has recently been used to treat delirium among intubated critically ill patients. However, the efficacy of dexmedetomidine for delirium in non-intubated critically ill patients remains unknown. We hypothesize that dexmedetomidine is superior to haloperidol for sedation of patients with hyperactive delirium, and would reduce the prevalence of delirium among non-intubated patients after administration. We will conduct a randomized controlled trial to compare dexmedetomidine and haloperidol for the treatment of nocturnal hyperactive delirium in non-intubated patients in high dependency units (HDUs). Methods This is an open-label, parallel-group, randomized controlled trial to compare the efficacy and safety of dexmedetomidine and haloperidol for nocturnal hyperactive delirium in non-intubated patients at two HDUs of a tertiary hospital. We will recruit consecutive non-intubated patients who are admitted to the HDU from the emergency room, and allocate them in a 1:1 ratio to the dexmedetomidine or haloperidol group in advance. The allocated investigational drug will be administered only when participants develop hyperactive delirium (Richmond Agitation-Sedation Scale [RASS] score ≥1 and a positive score on the Confusion Assessment Method for the ICU between 19:00 and 6:00 the next day) during the night at an HDU. Dexmedetomidine is administered continuously, while haloperidol is administered intermittently. The primary outcome is the proportion of participants who achieve the targeted sedation level (RASS score of between -3 and 0) 2h after the administration of the investigational drug. Secondary outcomes include the sedation level and prevalence of delirium on the day following the administration of the investigational drugs, and safety. We plan to enroll 100 participants who develop nocturnal hyperactive delirium and receive one of the two investigational drugs. Discussion This is the first randomized controlled trial to compare the efficacy and safety of dexmedetomidine and haloperidol for sedation of non-intubated critically ill patients with hyperactive delirium in HDUs. The results of this study may confirm whether dexmedetomidine could be another option to sedate patients with hyperactive delirium. Trial registration Japan Registry of Clinical Trials, jRCT1051220015, registered on 21 April 2022.

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“…273 A 2021 meta-analysis of 10 randomized trials and 5 observational studies evaluated the efficacy of dexmedetomidine in treating delirium; in one trial, dexmedetomidine shortened the duration of delirium; in 6 studies, it was associated with a lower pointprevalence of delirium and a shorter time to resolution of delirium; in 4 trials, it was superior to haloperidol in shortening the time to delirium resolution. 274 Dexmedetomidine is a promising agent for delirium treatment. On the contrary, benzodiazepines should not be used to treat agitated delirious patients unless their use is specifically indicated such as for the treatment of alcohol or benzodiazepine withdrawal.…”

Section: Treatment For Postoperative Deliriummentioning

confidence: 99%

“…However, the results were based on a single study 273 . A 2021 meta‐analysis of 10 randomized trials and 5 observational studies evaluated the efficacy of dexmedetomidine in treating delirium; in one trial, dexmedetomidine shortened the duration of delirium; in 6 studies, it was associated with a lower point‐prevalence of delirium and a shorter time to resolution of delirium; in 4 trials, it was superior to haloperidol in shortening the time to delirium resolution 274 . Dexmedetomidine is a promising agent for delirium treatment.…”

Section: Treatment For Perioperative Ncdsmentioning

confidence: 99%

Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment

Kong

Wang

2022

CNS Neurosci Ther

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Role of dexmedetomidine in the treatment of delirium in critically ill patients: a systematic review and meta-analysis

Cited by 10 publications

References 22 publications

Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

Dexmedetomidine versus haloperidol for sedation of non-intubated patients with hyperactive delirium during the night in a high dependency unit: study protocol for an open-label, parallel-group, randomized controlled trial (DEX-HD trial)

Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment

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