04 Mar Dexmedetomidine Reduced Risk of Delirium
MedicalResearch.com Interview with:
Yoanna Skrobik MD FRCP(c) MSc
McGill University Health Centre
MedicalResearch.com: What is the background for this study?
Response: My clinical research interests revolve around critical care analgesia, sedation, and delirium. I validated the first delirium screening tool in mechanically ventilated ICU patients (published in 2001), described ICU delirium risk factors, associated outcomes, compared treatment modalities and described pharmacological exposure for the disorder. I was invited to participate in the 2013 Society of Critical Care Medicine Pain, Anxiety, and Delirium management guidelines, and served as the vice-chair for the recently completed Pain, Agitation, Delirium, Early Mobility and Sleep upcoming guidelines.
Until this study, no pharmacological prevention or intervention could convincingly be considered effective in ICU delirium. Although Haloperidol and other antipsychotics are frequently used in practice, their lack of efficacy and possible disadvantages are increasingly being understood.
MedicalResearch.com: What are the main findings?
Response: This is the first study suggesting an effective pharmacological preventative approach to ICU delirium, a morbid and distressful disorder. Dexmedetomidine, a wakefulness-preserving anxiolytic, when administered at night, led to patients randomized to this arm being more likely to remain free of delirium free in the ICU (80% vs. 54%) and spending more ICU days free of delirium (8 vs. 6 days).
Dexmedetomidine has been described as a co-analgesic in many (non-ICU and ICU) studies. We found that among patients with pain, dexmedetomidine recipients were less likely to experience severe pain. (44 % vs. 66 %, p=0.04).
MedicalResearch.com: What should readers take away from your report?
Response: In patients at high risk for delirium, low-dose nocturnal dexmedetomidine infusions reduce delirium incidence.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We expected dexmedetomidine would also improve sleep quality, as previous studies in selected groups of critically ill patients suggested this might be the case. Commonly used nocturnal sedatives reduce sleep quality. However, no difference in sleep quality as assessed by a self-reported questionnaire was found between the two groups.
Sleep quality research is in its infancy. The recently completed 2018/9 Pain, Agitation/sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep (disruption) (PADIS) guidelines built on earlier work and the 2013 PAD guidelines by adding two inextricably related clinical care topics–rehabilitation/mobilization and sleep. Additional studies are required to define the influence of critical illness, delirium, and mechanical ventilation on sleep quality.
Yoanna Skrobik, Matthew S. Duprey, Nicholas S Hill, John W. Devlin. Low-dose Nocturnal Dexmedetomidine Prevents ICU Delirium: A Randomized, Placebo-controlled Trial. American Journal of Respiratory and Critical Care Medicine, 2018; DOI: 10.1164/rccm.201710-1995OC
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