Dexmedetomidine and delirium in the ICU

Delirium is a common problem encountered in the care of critically ill patients. It is characterized by an acute onset of impaired cognitive functioning that has a fluctuating course with impairment in a patient’s ability to process information (1). There are many proposed pathophysiologic mechanisms for delirium including decreased cholinergic activity, increased dopaminergic activity and changes in serotonergic activity (2). ICU patients seem to be at high risk of developing delirium. There are many risk factors for the development of delirium that commonly occur in ICU patients including fever, sepsis, pressor requirements and the use of medications such as benzodiazepines, opiates and anticholinergics (2). Mechanically ventilated patients appear to be at especially high risk for developing delirium during their stay in the ICU (1). There is strong evidence that in mechanically ventilated patient’s delirium is an independent predictor of mortality and prolonged hospitalization (3).