Dexmedetomidine for hyperactive delirium: worth further study

In their recent work, reported in Critical Care Medicine, Carrasco et al. have investigated dexmedetomidine as a rescue agent for treatment of hyperactive delirium refractory to continuous intravenous haloperidol in non-intubated intensive care unit (ICU) patients. The authors address a highly significant critical care issue of delirium with a medical ICU incidence of 50% to 80% (1). A variety of risk factors have been identified for delirium; the most well established risk factors include pre-existing dementia, severity of illness, history of alcoholism, history of hypertension and ICU medications such as benzodiazepines (1). Ultimately, delirium portends poor ICU outcomes of worsened long term cognition, increased length of ICU and hospital stay, increased length of mechanical ventilation, higher mortality and higher healthcare costs (2-10). Despite best efforts, the field, as of the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation and Delirium in Adult Patients in the ICU (PAD guidelines), continues to lack definitive data regarding prevention and treatment methods for ICU delirium.