Early goal-directed sedation with dexmedetomidine is associated with lower delirium rate in mechanically ventilated patients

Delirium remains a critical complication in mechanically ventilated ICU patients, with deep sedation strategies implicated in its pathogenesis. This study evaluates whether an early goal-directed sedation (EGDS) strategy is associated with delirium rate and clinical outcomes in mechanically ventilated patients. In this single-center retrospective cohort study, 412 mechanically ventilated adults from a tertiary ICU (2022–2024) were categorized into EGDS (n = 208) and conventional sedation (n = 204) groups. The EGDS protocol included dexmedetomidine titration (RASS − 2 to 0), nurse-driven, protocolized targeted sedation and multimodal analgesia (BPS ≤ 3). Primary outcome was delirium rate (CAM-ICU); secondary outcomes encompassed mechanical ventilation duration, ICU stay, and safety events. Delirium rate was significantly lower in the EGDS group (32.2% vs. 48.0%, P < 0.001). EGDS patients demonstrated shorter median mechanical ventilation duration (4 vs. 5 days, P = 0.003) and ICU stay (6 vs. 8 days, P = 0.001). Adverse events including hypotension (12.0% vs. 18.6%, P = 0.048) and respiratory suppression (5.3% vs. 10.3%, P = 0.032) were fewer with EGDS. Cox regression showed EGDS was associated with a 44% lower hazard of delirium (aHR = 0.56, 95% CI 0.39–0.81). In this retrospective cohort, patients who achieved EGDS goals had a lower observed delirium rate and shorter ICU stay; these findings are associative and do not establish causality. These real-world findings suggest associations between EGDS and improved outcomes, supporting further evaluation of protocolized sedation strategies.