Dexmedetomidine increases the risk of delirium in critically ill patients: A propensity score analysis

Delirium frequently affects patients in intensive care units (ICUs). Dexmedetomidine (DEX), a sedative with limited respiratory depressant effects, may be advantageous for preventing sedation-related delirium. Current evidence on the potential association between DEX and delirium is mixed, and the specific relationship between DEX administration within 24 hours and delirium occurrence remains unclear. This study investigated the risk and outcomes of delirium in ICU patients who received DEX within 24 hours preceding a delirium assessment, compared to those who did not. A systematic analysis of data extracted from the MIMIC-III v1.4, MIMIC-IV v0.4, and eICU collaborative research databases was conducted. Two patient cohorts were formed to assess the relative risks of delirium, mortality, ICU and hospital lengths of stay, and the likelihood of home discharge within the preceding 24 hours following DEX administration. Propensity score matching (1:1) ensured balance within the matched cohort and aided in identifying potential prognostic factors. Multinomial regression modeling and propensity score calculations were employed for statistical analysis. Among 78,364 patients analyzed, 22,159 (28.28%) had positive delirium records. Propensity matching yielded 4666 patients (2333 per treatment group) with balanced covariates. DEX administration significantly increased the risk of delirium (P < .001). It was also associated with extended ICU stay (P < .001) but surprisingly showed lower mortality (P < .001). Patients treated with DEX had greater odds of home discharge (P < .01) with no significant difference in hospitalization duration (P = .06). DEX was independently associated with delirium in critically ill patients.