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BioMed Research International
Volume 2015, Article ID 635737, 7 pages
http://dx.doi.org/10.1155/2015/635737
Review Article

Defining the Role of Dexmedetomidine in the Prevention of Delirium in the Intensive Care Unit

1Critical Care, Hospital Pharmacy Services, Mayo Clinic, Rochester, MN 55905, USA
2Department of Pharmacy Practice, Campbell University School of Pharmacy and Health Sciences, Buies Creek, NC 27506, USA
3Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC 27710, USA
4Department of Clinical Pharmacy, University of Tennessee Medical Center, Knoxville, TN 37920, USA
5Departments of Anesthesiology and Medicine, Duke University Medical Center, Durham VAMC, Durham, NC 27710, USA
6Department of Medicine, Duke University, Durham, NC 27710, USA

Received 18 December 2014; Revised 23 April 2015; Accepted 23 April 2015

Academic Editor: Elizabeth Papathanassoglou

Copyright © 2015 S. Nelson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Dexmedetomidine is a highly selective 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.