Association of dexmedetomidine with improved survival in ICU delirium

Intensive care unit (ICU) delirium is common in critically ill patients and portends poor outcomes. Although dexmedetomidine (DEX) provides arousable sedation and possible neuroprotection, its survival benefit in established ICU delirium remains unclear. This study assessed the association between DEX initiation within 24 h of ICU admission and mortality in patients with early ICU delirium.

This retrospective cohort study used data from the Medical Information Market for Intensive Care IV database. ICU patients with a positive Confusion Assessment Method for the ICU screen on the first ICU day were included. The propensity score matching balanced baseline characteristics and interventions between the DEX and non-DEX groups. Kaplan-Meier and Cox regression analyses were used to assess ICU mortality, 30-day and 90-day all-cause mortality post ICU admission, together with the dose-response correlations with average daily DEX dose.

Among 7,441 eligible patients, matching yielded 2,596 patients, with 1,298 in each group. Mortality was lower in the DEX group than in the non-DEX group (13.33% vs. 18.18%, P = 0.001). Kaplan-Meier analysis showed better 30-day and 90-day survival in the DEX group.Fully adjusted Cox modeling showed DEX use associated with improved survival. (HR 0.67; 95%CI: 0.54-0.82; P < 0.001). This survival advantage persisted across subgroups and showed a dose-response pattern, with a higher daily DEX dose linked to better 30-day and 90-day survival.

Early DEX administration was associated with improved short- and long-term survival in ICU patients with delirium. Prospective randomized trials are warranted.