The association between dexmedetomidine use and delirium in critically ill surgical patients: a retrospective cohort study

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Background: Delirium is a common complication among critically ill patients. This study analyzed trends in dexmedetomidine use and its association with delirium incidence, severity, and outcomes in a surgical intensive care unit (ICU). Methods: A retrospective cohort study was performed in the surgical ICU of a tertiary academic center in South Korea, including 6,140 adult patients admitted from 2017 to 2023. Patients were grouped by dexmedetomidine exposure. Delirium was assessed using the Intensive Care Delirium Screening Checklist (ICDSC). Outcomes included delirium incidence, ICU length of stay (LOS), and one-year postoperative survival. Multivariate logistic regression identified delirium risk factors; Kaplan-Meier analysis assessed survival. Results: Dexmedetomidine use increased over time. Patients receiving dexmedetomidine had higher delirium incidence (46.1% vs. 13.9%, P < 0.001) and longer ICU stays (5.7 vs. 2.1 d, P < 0.001). They received 0.37 ± 0.16 µg/kg/h for 9.4 ± 6.5 h/d over 2.3 ± 4.0 d on average. Independent delirium risk factors were dexmedetomidine use (odds ratio [OR] 3.14; 95% CI 2.43-4.06), older age, psychiatric medication, and higher American Society of Anesthesiologists (ASA) physical status classification and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. One-year postoperative survival was lower in the dexmedetomidine group (92.7% vs. 94.5%, P = 0.015), likely due to greater illness severity. Conclusions: Dexmedetomidine was mainly used in high-risk, severely ill patients, reflecting its role in managing severe symptoms rather than preventing delirium. These results highlight the need for personalized sedation strategies to optimize dexmedetomidine use in the ICU setting.

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