- Delirium occurs in about 31% of ICU adults and is associated with longer hospital stays, more complications, increased mortality, higher costs, and worse long-term cognition and independence.
- Current medical options for the treatment of delirium such as haloperidol and atypical antipsychotics are not recommended for routine use in the ICU because of limited evidence and potential harm.
- Dexmedetomidine is a potential treatment option for treating delirium, but its effectiveness is not well established.
- This single-center randomized controlled trial compared the efficacy of dexmedetomidine versus propofol in treating adults with hyperactive or mixed delirium in the ICU.
- Patients with an Intensive Care Delirium Screening Checklist score ≥4 (a validated marker for delirium in the intensive care setting) for two consecutive shifts were eligible to be enrolled in the study.
- Enrolled patients were randomized to receive infusions of either propofol or dexmedetomidine, with infusions occurring nightly (20:00–06:00) until delirium resolved or treatment ended.
- The primary outcome was delirium duration. Median delirium duration was shorter with dexmedetomidine than with propofol (Intention-to-Treat [ITT]: 34 vs 66 h; Per protocol [PP]: 31 vs 66 h). The PP analysis showed a significant benefit (HR 2.95; 95% CI 1.27–6.86), but the ITT analysis did not reach significance. In PP analyses, dexmedetomidine was also associated with lower 28-day mortality, less need for ventilation, and shorter ICU and hospital lengths of stay.
- The authors concluded that dexmedetomidine may be more effective than propofol for treating hyperactive and mixed delirium in the ICU setting.
- A significant limitation of this study was that, due to slow enrollment, the authors ultimately only enrolled 38 of the planned 316 patients. Consequently, the study was severely underpowered and these results should only be regarded as being preliminary and exploratory.
Summary of "Comparison of Propofol and Dexmedetomidine Infused Overnight to Treat Hyperactive and Mixed ICU Delirium: A Prospective Randomised Controlled Clinical Trial"
Summary published March 30, 2026
