Dexmedetomidine in prevention and treatment of postoperative and intensive care unit delirium: A systematic review and meta-analysis
Open accessAbstract
To determine the preventive and therapeutic effect of dexmedetomidine on intensive care unit (ICU) delirium. The literature search using PubMed and the Cochrane Central Register of Controlled Trials was performed (August 1, 2018) to detect all randomized controlled trials (RCTs) of adult ICU patients receiving dexmedetomidine. Articles were included if they assessed the influence of dexmedetomidine compared to a sedative agent on incidence of ICU delirium or treatment of this syndrome. Accordingly, relevant articles were allocated to the following two groups: (1) articles that assessed the delirium incidence (incidence comparison) or articles that assessed the treatment of delirium (treatment comparison). Incidence of delirium and delirium resolution were the primary outcomes. We combined treatment effects comparing dexmedetomidine versus (1) placebo, (2) standard sedatives, and (3) opioids in random-effects meta-analyses. Risk of bias for each included RCT was assessed following Cochrane standards. The literature search resulted in 28 articles (25 articles/4975 patients for the incidence comparison and three articles/166 patients for the treatment comparison). In the incidence comparison, heterogeneity was present in different subgroups. Administration of dexmedetomidine was associated with significantly lower overall incidence of delirium when compared to placebo (RR 0.52; 95% CI 0.39–0.70; I 2 = 37%), standard sedatives (RR 0.63; 95% CI 0.46–0.86; I 2 = 69%), as well as to opioids (RR 0.61; 95% CI 0.44–0.83; I 2 = 0%). Use of dexmedetomidine significantly increased the risks of bradycardia and hypotension. Limited data were available on circulatory insufficiency and mortality. In the treatment comparison, the comparison drugs in the three RCTs were placebo, midazolam, and haloperidol. The resolution of delirium was measured differently in each study. Two out of the three studies indicated clear favorable effects for dexmedetomidine (i.e., compared to placebo and midazolam). The study comparing dexmedetomidine with haloperidol was a pilot study ( n = 20) with high variability in the results. Findings suggest that dexmedetomidine reduces incidence and duration of ICU delirium. Furthermore, our systematic searches show that there is limited evidence if a delirium shall be treated with dexmedetomidine.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Dexmedetomidine is shown to be effective in delirium prevention and treatment in adults.
“Instead, clinicians are encouraged to use the ABCDEF bundle (Table 6) and consider dexmedetomidine, shown to be effective in delirium prevention and treatment in adults [81].”
From Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness (2022) · cites this paper as [81]
The Abstract Results report a lower incidence of delirium with dexmedetomidine in adult ICU patients, supporting the prevention claim. But the Abstract Conclusion says evidence for treating established delirium is limited; the treatment comparison comprised only three trials, so the paper does not establish effectiveness for treatment in adults generally. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164 · see citing works
Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series
(2008) · doi:10.1002/9780470712184 · Cited by 25,048 · see citing works
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,577 · see citing works
Duval, S., & Tweedie, R. (2000) · Biometrics · doi:10.1111/j.0006-341x.2000.00455.x · Cited by 14,099 · see citing works
Wan, X., Wang, W., Liu, J., & Tong, T. (2014) · BMC Medical Research Methodology · doi:10.1186/1471-2288-14-135 · Cited by 11,735 · see citing works
Cochrane Handbook for Systematic Reviews of Interventions
Higgins, J. P. T., Green, S., & Ben Van Den, A. (2020) · International Coaching Psychology Review · doi:10.53841/bpsicpr.2020.15.2.123 · Cited by 5,670 · see citing works
Luo, D., Wan, X., Liu, J., & Tong, T. (2018) · Statistical Methods in Medical Research · doi:10.1177/0962280216669183 · Cited by 4,066 · see citing works
Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F., Davidson, J. E., Devlin, J. W., Kress, J. P., Joffe, A. M., et al. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e3182783b72 · Cited by 3,785 · see citing works
Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit
Ely, E. W. (2004) · JAMA · doi:10.1001/jama.291.14.1753 · Cited by 3,073 · see citing works
A Nonparametric “Trim and Fill” Method of Accounting for Publication Bias in Meta-Analysis
Duval, S., & Tweedie, R. (2000) · Journal of the American Statistical Association · doi:10.1080/01621459.2000.10473905 · Cited by 2,955 · see citing works
Pandharipande, P. P., Pun, B. T., Herr, D., Maze, M., Girard, T. D., Miller, R. R., Shintani, A., Thompson, J. L., Jackson, J. C., Deppen, S. A., et al. (2007) · JAMA · doi:10.1001/jama.298.22.2644 · Cited by 1,456 · see citing works
Precipitating Factors for Delirium in Hospitalized Elderly Persons
Inouye, S. K. (1996) · JAMA · doi:10.1001/jama.1996.03530350034031 · Cited by 1,430 · see citing works
Pandharipande, P. P., Shintani, A., Peterson, J. F., Pun, B. T., Wilkinson, G. R., Dittus, R. S., Bernard, G. R., & Ely, E. W. (2005) · Anesthesiology · doi:10.1097/00000542-200601000-00005 · Cited by 1,231 · see citing works
Dexmedetomidine vs Midazolam or Propofol for Sedation During Prolonged Mechanical Ventilation
Jakob, S. M. (2012) · JAMA · doi:10.1001/jama.2012.304 · Cited by 1,022 · see citing works
Inouye, S. K., Viscoli, C. M., Horwitz, R. I., Hurst, L. D., & Tinetti, M. E. (1993) · Annals of Internal Medicine · doi:10.7326/0003-4819-119-6-199309150-00005 · Cited by 854 · see citing works
Su, X. W., Meng, Z., Wu, X., Cui, F., Li, H.-L., Wang, D., Zhu, X. D., Zhu, S., Maze, M., & Ma, D. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30580-3 · Cited by 800 · see citing works
Delirium in the intensive care unit
Girard, T. D., Pandharipande, P. P., & Ely, E. W. (2008) · Critical Care · doi:10.1186/cc6149 · Cited by 628 · see citing works
Pandharipande, P. P., Cotton, B. A., Shintani, A., Thompson, J. L., Pun, B. T., Morris, J. A., Dittus, R. S., & Ely, E. W. (2008) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0b013e31814b2c4d · Cited by 560 · see citing works
Venn, R. M., Bradshaw, C. J., Spencer, R. C., et al. (1999) · Anaesthesia · doi:10.1046/j.1365-2044.1999.01114.x · Cited by 537 · see citing works
Dexmedetomidine and the Reduction of Postoperative Delirium after Cardiac Surgery
Maldonado, J. R., Wysong, A. S., van der Starre, P., Block, T. S., Miller, D. C., & Reitz, B. A. (2009) · Psychosomatics · doi:10.1176/appi.psy.50.3.206 · Cited by 461 · see citing works
Reade, M. C., Eastwood, G. M., Bellomo, R., Bailey, M., Bersten, A. D., Cheung, B. K., Davies, A., Delaney, A. P., Ghosh, A., van Haren, F. M. P., et al. (2016) · JAMA · doi:10.1001/jama.2016.2707 · Cited by 376 · see citing works
Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery
Djaiani, G. N., Silverton, N. A., Fedorko, L., Carroll, J. A., Styra, R. G., Rao, V., & Katznelson, R. (2015) · Anesthesiology · doi:10.1097/aln.0000000000000951 · Cited by 372 · see citing works
Herr, D., Sum-Ping, S. T., & England, M. R. (2003) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1016/s1053-0770(03)00200-3 · Cited by 358 · see citing works
Deiner, S. G., Luo, X., Lin, H., et al. (2017) · JAMA Surgery · doi:10.1001/jamasurg.2017.1505 · Cited by 334 · see citing works
Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep
Huupponen, E., Maksimow, A. T., Lapinlampi, P., Särkelä, M. O. K., Saastamoinen, A., Snapir, A., Scheinin, H., Scheinin, M., Meriläinen, P., Himanen, S., et al. (2007) · Acta Anaesthesiologica Scandinavica · doi:10.1111/j.1399-6576.2007.01537.x · Cited by 325 · see citing works
Shehabi, Y., Grant, P. W., Wolfenden, H. D., Hammond, N. E., Bass, F. E., Campbell, M., & Chen, J. (2009) · Anesthesiology · doi:10.1097/aln.0b013e3181b6a783 · Cited by 325 · see citing works
Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial
Skrobik, Y. K., Duprey, M. S., Hill, N. S., & Devlin, J. W. (2018) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201710-1995oc · Cited by 304 · see citing works
Tan, J. A., & Ho, K. M. (2010) · Intensive Care Medicine · doi:10.1007/s00134-010-1877-6 · Cited by 282 · see citing works
Delirium in the Cardiovascular ICU
McPherson, J., Wagner, C. E., Boehm, L. M., Hall, J. D., Johnson, D., Miller, L. R., Burns, K., Thompson, J. L., Shintani, A., Ely, E. W., et al. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e31826ab49b · Cited by 277 · see citing works
Mantz, J., Josserand, J., & Hamada, S. (2010) · European Journal of Anaesthesiology · doi:10.1097/eja.0b013e32833e266d · Cited by 273 · see citing works
Reade, M. C., O’Sullivan, K., Bates, S., Goldsmith, D., Ainslie, W. R., & Bellomo, R. (2009) · Critical Care · doi:10.1186/cc7890 · Cited by 265 · see citing works
Duan, X., Coburn, M., Rossaint, R., Sanders, R. D., Waesberghe, J. V., & Kowark, A. (2018) · British Journal of Anaesthesia · doi:10.1016/j.bja.2018.04.046 · Cited by 246 · see citing works
Kawazoe, Y., Miyamoto, K., Morimoto, T., Yamamoto, T., Fuke, A., Hashimoto, A., Koami, H., Beppu, S., Katayama, Y., Itoh, M., et al. (2017) · JAMA · doi:10.1001/jama.2017.2088 · Cited by 242 · see citing works
Dexmedetomidine in anaesthesia
Paris, A., & Tonner, P. H. (2005) · Current Opinion in Anaesthesiology · doi:10.1097/01.aco.0000174958.05383.d5 · Cited by 238 · see citing works
Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation
Ruokonen, E., Parviainen, I., Jakob, S. M., Nunes, S. L., Kaukonen, M., Shepherd, S. T., Sarapohja, T., Bratty, J. R., Takala, J. A., & For the “Dexmedetomidine for Continuous Sedation” Investigators (2008) · Intensive Care Medicine · doi:10.1007/s00134-008-1296-0 · Cited by 235 · see citing works
Lonergan, E., Luxenberg, J., & Areosa Sastre, A. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006379.pub3 · Cited by 223 · see citing works
The intensive care delirium research agenda: a multinational, interprofessional perspective
Pandharipande, P. P., Ely, E. W., Arora, R. C., Balas, M. C., Boustani, M. A., Calle, G. H. L., Cunningham, C. M., Devlin, J. W., Elefante, J., Han, J. H., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4860-7 · Cited by 211 · see citing works
Corbett, S. M., Rebuck, J. A., Greene, C. M., et al. (2005) · Critical Care Medicine · doi:10.1097/01.ccm.0000162565.18193.e5 · Cited by 160 · see citing works
Li, X., Yang, J. Y., Nie, X.-L., Zhang, Y., Li, X., Li, L., Wang, D., & Ma, D. (2017) · PLoS ONE · doi:10.1371/journal.pone.0170757 · Cited by 160 · see citing works
Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients
Chen, K., Lü, Z., Yi, X., Cai, Y., Chen, Y., & Pan, S. M. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010269.pub2 · Cited by 155 · see citing works
Coull, J. T., Jones, M. E. P., Egan, T. D., Frith, C., & Maze, M. (2004) · NeuroImage · doi:10.1016/j.neuroimage.2003.12.022 · Cited by 150 · see citing works
Sedation and analgesia in the intensive care unit: Evaluating the role of dexmedetomidine
Szumita, P. M., Baroletti, S. A., Anger, K. E., & Wechsler, M. E. (2006) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp050508 · Cited by 127 · see citing works
Pasin, L., Landoni, G., Nardelli, P., Belletti, A., Prima, A. L. D., Taddeo, D., Isella, F., & Zangrillo, A. (2014) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2014.03.010 · Cited by 125 · see citing works
Dexmedetomidine Versus Midazolam for the Sedation of Patients with Non-invasive Ventilation Failure
Huang, Z., Chen, Y.-S., Yang, Z., & Liu, J. (2012) · Internal Medicine · doi:10.2169/internalmedicine.51.7810 · Cited by 118 · see citing works
Lonergan, E., Luxenberg, J. S., Sastre, A. A., & Wyller, T. B. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006379.pub2 · Cited by 111 · see citing works
Delirium in Critically Ill Patients
Zaal, I. J., & Slooter, A. J. C. (2012) · Drugs · doi:10.2165/11635520-000000000-00000 · Cited by 110 · see citing works
Role of Dexmedetomidine for the Prevention and Treatment of Delirium in Intensive Care Unit Patients
Mo, Y., & Zimmermann, A. E. (2013) · Annals of Pharmacotherapy · doi:10.1345/aph.1ar708 · Cited by 109 · see citing works
Xia, Z.-Q., Chen, S., Yao, X., et al. (2013) · Journal of Surgical Research · doi:10.1016/j.jss.2013.06.062 · Cited by 103 · see citing works
Lee, C., Lee, C., Lee, G., Lee, M.-J., & Hwang, J. (2018) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2018.03.007 · Cited by 98 · see citing works
Park, J. B., Bang, S. H., Chee, H. K., et al. (2014) · The Korean Journal of Thoracic and Cardiovascular Surgery · doi:10.5090/kjtcs.2014.47.3.249 · Cited by 87 · see citing works
Contribution of sedative-hypnotic agents to delirium via modulation of the sleep pathway
Sanders, R. D., & Maze, M. (2010) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-010-9421-2 · Cited by 86 · see citing works
Liu, Y., Ma, L., Gao, M., Guo, W., & Ma, Y. (2015) · Aging Clinical and Experimental Research · doi:10.1007/s40520-015-0492-3 · Cited by 81 · see citing works
Liu, X., Zhang, K., Wang, W., Xie, G., Cheng, B., Wang, Y., Hu, Y., & Fang, X. (2016) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2016.05.038 · Cited by 74 · see citing works
Mei, B., Meng, G., Xu, G., et al. (2018) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000605 · Cited by 72 · see citing works
Nussbaumer-Streit, B., Klerings, I., Wagner, G., Heise, T. L., Dobrescu, A. I., Armijo-Olivo, S., Stratil, J. M., Persad, E., Lhachimi, S. K., Van Noord, M. G., et al. (2018) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2018.05.022 · Cited by 72 · see citing works
Devlin, J. W., Al‐Qadheeb, N. S., Chi, A., Roberts, R. J., Qawi, I., Garpestad, E., & Hill, N. S. (2014) · CHEST Journal · doi:10.1378/chest.13-1448 · Cited by 71 · see citing works
Priye, S., Jagannath, S., Singh, D., Shivaprakash, S., & Reddy, D. P. (2015) · Saudi Journal of Anaesthesia · doi:10.4103/1658-354x.154715 · Cited by 70 · see citing works
Yang, X., Li, Z., Gao, C., & Liu, R. (2015) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2015.01.011 · Cited by 63 · see citing works
Postoperative Delirium in Cardiac Surgery: An Unavoidable Menace?
Hollinger, A., Siegemund, M., Goettel, N., & Steiner, L. A. (2015) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2014.08.021 · Cited by 56 · see citing works
Self-citationDexmedetomidine in Cardiac Surgery Patients Who Fail Extubation and Present with a Delirium State
Yapıcı, N., Çoruh, T., Kehlіbar, T., et al. (2011) · The Heart Surgery Forum · doi:10.1532/hsf98.201011102 · Cited by 49 · see citing works
MacLaren, R., Preslaski, C. R., Mueller, S. W., Kiser, T. H., Fish, D. N., Lavelle, J. C., & Malkoski, S. P. (2013) · Journal of Intensive Care Medicine · doi:10.1177/0885066613510874 · Cited by 42 · see citing works
Sheikh, T. A., Dar, B., Akhter, N., et al. (2018) · Anesthesia Essays and Researches · doi:10.4103/aer.aer_46_18 · Cited by 41 · see citing works
Altering Intensive Care Sedation Paradigms to Improve Patient Outcomes
Riker, R. R., & Fraser, G. L. (2011) · Anesthesiology Clinics · doi:10.1016/j.anclin.2011.09.006 · Cited by 31 · see citing works
Comparison of dexmedetomidine versus propofol on hemodynamics in surgical critically ill patients
Chang, Y.-F., Chao, A., Shih, P.-Y., et al. (2018) · Journal of Surgical Research · doi:10.1016/j.jss.2018.03.040 · Cited by 27 · see citing works
Li, Y., Yu, Z.-X., Ji, M.-S., et al. (2017) · Journal of Intensive Care Medicine · doi:10.1177/0885066617710643 · Cited by 23 · see citing works
Hollinger, A., Ledergerber, K., von Felten, S., Sutter, R., Rüegg, S. J., Gantner, L., Zimmermann, S., Blum, A., Steiner, L. A., Marsch, S. C. U., et al. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-015783 · Cited by 16 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- [15]Barr J Fraser GL Puntillo K Ely EW Gélinas C Dasta JF Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit Crit Care Med 2013 41 263 306 10.1097/CCM.0b013e3182783b72 23269131 · DOI
Cited by
Sorted by citations
Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness
Nibras, S., Kentor, R., Masood, Y., Price, K., Schneider, N. M., Tenenbaum, R. B., & Calarge, C. (2022) · Children · doi:10.3390/children9071051 · Cited by 25 · see citing works
“Instead, clinicians are encouraged to use the ABCDEF bundle (Table 6) and consider dexmedetomidine, shown to be effective in delirium prevention and treatment in adults [81].”
Background
- Authors
- Flükiger, J., Hollinger, A., Speich, B., Meier, V., Tontsch, J., Zehnder, T., & Siegemund, M.
- Affiliations
- University Hospital of Basel (CH)
- Inserm (FR)
- University of Basel (CH)
- Corresponding author
- Hollinger, Alexa
- Venue
- Annals of Intensive Care
- Publisher
- Elsevier BV
- Published
- 2018
- Volume
- 8
- Issue
- 1
- Pages
- 92
- ISSN
- 2110-5820 (ISSN-L)
- PMC
- PMC6148680
- OpenAlex
- W2891292668
- Cited by
- 92
- References
- 68
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 13 · 2023: 6 · 2022: 17 · 2021: 19 · 2020: 9 · 2019: 8 · 2018: 1 · 2017: 1
- FWCI
- 1.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Annals of Intensive Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- dexmedetomidine, ICU delirium, postoperative delirium, delirium prevention, delirium management, sedatives, opioids, midazolam, haloperidol, bradycardia, hypotension, delirium resolution, intensive care unit patients, critically ill adults, delirium incidence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
