The Effectiveness of Dexmedetomidine for Treating Delirium in the Intensive Care Units

Introduction: Delirium is a common and serious condition among ICU patients, characterized by acute changes in mental status, inattention, and either altered consciousness or disorganized thinking. It is linked to increased mortality, prolonged ICU stays, and higher healthcare costs. The Confusion Assessment Method for the ICU (CAM-ICU) is widely used to diagnose and monitor delirium. While dexmedetomidine has been associated with lower delirium rates compared to benzodiazepines, its overall impact on ICU delirium remains uncertain. The objective of the study is to determine whether dexmedetomidine administration is associated with a significant reduction in CAM-positive scores.


Methods: In this single-center, retrospective observational study, adult patients with delirium, identified using the CAM-ICU, were included between January 1 to October 31, 2024. Patients were excluded if they were receiving palliative care, had alcohol withdrawal, or were on scheduled or continuous benzodiazepine infusions. Patients were stratified by dexmedetomidine exposure. The primary outcome was CAM-ICU conversion to negative within 24 hours of dexmedetomidine initiation. Secondary outcomes included delirium persistence at 48 and 72 hours, ICU and hospital length of stay. Categorical and continuous variables were analyzed using chi-square and t-tests, respectively.


Results: Among 21 CAM-ICU–positive patients, 41.7% in the dexmedetomidine group converted to negative within 24 hours, and 25% remained negative at 72 hours. No significant differences in delirium resolution were observed between groups at 24 or 48 hours. At 72 hours, the non-dexmedetomidine group showed a non-significant trend toward improvement. Dexmedetomidine was associated with a shorter median ICU stay (19 vs. 24 days) but longer hospital stay (45 vs. 24.5 days). Discontinuation due to adverse events was low (4.8%), with hypotension being the most common (9.5%).


Conclusions: In conclusion, this study provides real-world evidence that dexmedetomidine may promote early resolution of ICU delirium while maintaining a favorable safety profile. Larger, prospective trials are warranted to validate these results and to identify patient populations most likely to derive meaningful benefit from dexmedetomidine-based strategies.