Hypothesis: A prophylactic intravenous infusion of low-dose dexmedetomidine will decrease delirium in patients over 65 years admitted to the ICU after non-cardiac surgery.
Methods: RCT, placebo controlled trial at 2 sites in China. Patients older than 65 years of age were randomized to receive IV dexmedetomidine (0.1 mcg/kg/hr) or placebo from the time of ICU admission to 0800 on POD 1.
Results: The incidence of delirium was reduced in the dexmedetomidine group (9.1% vs. 22.6%; OR 0.35). The time to extubation was shorter and the incidence of non-delirium complications was lower in the dexmedetomidine group.
Strengths: RCT, large sample size, placebo-controlled
Weaknesses: Baseline mental status not assessed, unclear ICU admission criteria, potential difficulty in generalizing to other cultures
Key Point: Low-dose, prophylactic dexmedetomidine may decrease delirium and other complications in elderly patients admitted to the ICU after non-cardiac surgery.