UMEM Educational Pearls

Title: Precedex for Delirium Prevention

Posted: 5/15/2018 by Ashley Menne, MD
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Precedex (dexmedetomidine) is a selective alpha-2 adrenergic receptor agonist used as a sedative.

It is unique among sedatives typically used in the ICU in that it lacks GABA activity and lacks anticholinergic activity.

Previous studies have shown significant positive changes in sleep patterns in critically ill patients sedated with dexmedetomidine:

-improved sleep efficiency – decreased sleep fragmentation, decreased stage 1 sleep, increased stage 2 sleep

-improved distribution of sleep (with more than ¾ sleep occurring at night)

Given importance of sleep and preservation of day-night cycles/ circadian rhythms in prevention of delirium, a recent randomized controlled trial evaluated dexmedetomidine's effect on delirium.

100 delirium-free critically ill adults receiving sedatives were randomized to receive nocturnal (21:30-06:15) IV dexmedetomidine (titrated to RASS -1 or max 0.7 mcg/kg/hr) OR placebo until ICU discharge.

80% of patients in the dexmedetomidine group remained delirium-free vs 54% in the placebo group.

There was no difference in the incidence of hypotension, bradycardia, or both between groups.

References

Alexopolou, et al. Effects of Dexmedetomidine on Sleep Quality in Critically Ill Patients. Anesthesiology 2014; 121:801-7.

Skrobic, et al. Low Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. Am J Respir Crit Care Med 2018; 197:9, 1147-56.