Shi He-Jie, Li Han-Wei, Lu Yi-Fei, Zhang Xin-Yun, Hu An-Min, Huo Jian
Department of Anesthesiology, Shenzhen People's Hospital, Shenzhen, China.
The Second Clinical Medical College, Jinan University, Shenzhen, China.
Medicine (Baltimore). 2025 May 30;104(22):e42589. doi: 10.1097/MD.0000000000042589.
Delirium frequently affects patients in intensive care units (ICUs). Dexmedetomidine (DEX), a sedative with limited respiratory depressant effects, may be advantageous for preventing sedation-related delirium. Current evidence on the potential association between DEX and delirium is mixed, and the specific relationship between DEX administration within 24 hours and delirium occurrence remains unclear. This study investigated the risk and outcomes of delirium in ICU patients who received DEX within 24 hours preceding a delirium assessment, compared to those who did not. A systematic analysis of data extracted from the MIMIC-III v1.4, MIMIC-IV v0.4, and eICU collaborative research databases was conducted. Two patient cohorts were formed to assess the relative risks of delirium, mortality, ICU and hospital lengths of stay, and the likelihood of home discharge within the preceding 24 hours following DEX administration. Propensity score matching (1:1) ensured balance within the matched cohort and aided in identifying potential prognostic factors. Multinomial regression modeling and propensity score calculations were employed for statistical analysis. Among 78,364 patients analyzed, 22,159 (28.28%) had positive delirium records. Propensity matching yielded 4666 patients (2333 per treatment group) with balanced covariates. DEX administration significantly increased the risk of delirium (P < .001). It was also associated with extended ICU stay (P < .001) but surprisingly showed lower mortality (P < .001). Patients treated with DEX had greater odds of home discharge (P < .01) with no significant difference in hospitalization duration (P = .06). DEX was independently associated with delirium in critically ill patients.
谵妄在重症监护病房（ICU）中经常影响患者。右美托咪定（DEX）是一种呼吸抑制作用有限的镇静剂，可能对预防与镇静相关的谵妄有益。目前关于DEX与谵妄之间潜在关联的证据不一，且在谵妄评估前24小时内使用DEX与谵妄发生之间的具体关系仍不清楚。本研究调查了在谵妄评估前24小时内接受DEX的ICU患者与未接受DEX的患者相比，发生谵妄的风险及预后情况。对从MIMIC-III v1.4、MIMIC-IV v0.4和eICU协作研究数据库中提取的数据进行了系统分析。形成了两个患者队列，以评估谵妄、死亡率、ICU和住院时间的相对风险，以及在使用DEX后的前24小时内出院回家的可能性。倾向评分匹配（1:1）确保了匹配队列中的平衡，并有助于识别潜在的预后因素。采用多项回归建模和倾向评分计算进行统计分析。在分析的78364例患者中，22159例（28.28%）有阳性谵妄记录。倾向匹配产生了4666例患者（每个治疗组2333例），协变量平衡。使用DEX显著增加了谵妄的风险（P <.001）。它还与ICU住院时间延长有关（P <.001），但令人惊讶的是死亡率较低（P <.001）。接受DEX治疗的患者出院回家的几率更高（P <.01），住院时间无显著差异（P =.06）。在危重症患者中，DEX与谵妄独立相关。
