Effects of Dexmedetomidine on Delirium in Trauma Intensive Care Unit (ICU) Patients: A Retrospective Cohort Study

Background While some studies suggest that dexmedetomidine is a strong prophylactic against delirium, there is a lack of compelling evidence supporting its use in critically ill patients who have suffered traumatic injuries requiring treatment in intensive care settings. The primary objective of this study was to evaluate the effect of dexmedetomidine on the incidence of delirium in trauma ICU patients. Given the absence of a significant association, a secondary analysis was conducted to identify independent predictors of delirium. Methods A retrospective cohort study was conducted among adult patients with traumatic injuries admitted to the surgical-trauma ICU at a level 1 trauma center between 2017 and 2021. Level 1 trauma centers serve as regional referral centers, often managing the most severe and complex trauma cases. Patients were categorized into the dexmedetomidine-based sedation group (receiving dexmedetomidine along with other concomitant sedatives) and the non-dexmedetomidine-based sedation group (receiving other sedative agents, excluding dexmedetomidine). Results Of the 272 patients included in the study, 163 (60%) were in the dexmedetomidine-based sedation group. The incidence of delirium was comparable between dexmedetomidine-based and non-dexmedetomidine-based sedation groups (13.0% vs. 9.2%, p = 0.33). The risk of delirium was approximately threefold higher in patients with a pre-existing psychiatric illness (OR = 2.65, 95% CI 1.14-6.30, p = 0.02) and almost fourfold in patients with exposure to benzodiazepine (OR = 3.90, 95% CI 1.36-11.72, p = 0.02). Conclusions This study adds to the existing literature by presenting data on the incidence of delirium among trauma patients and assessing how dexmedetomidine affects its prevalence. The findings align with the current body of research, highlighting that pre-existing psychiatric conditions and benzodiazepine use are recognized risk factors for delirium in the trauma ICU population. Nevertheless, dexmedetomidine administration was not found to significantly influence the likelihood of developing delirium in these patients.