Photo Credit: Ulianna
The following is a summary of “Prevention of post-operative delirium using an overnight infusion of dexmedetomidine in patients undergoing cardiac surgery: a pragmatic, randomized, double-blind, placebo-controlled trial,” published in the February 2024 issue of Critical Care by Huet et al.
Despite its significant negative impact on patient outcome, post-operative delirium (PoD) after cardiac surgery lacks specific treatment, and research suggests an association between this condition and poor sleep in critically ill patients.
Researchers conducted a retrospective study to investigate whether enhancing sleep with an overnight dexmedetomidine infusion diminishes the occurrence of delirium following cardiac surgery.
They conducted a randomized trial (January 2019 to July 2021). Eligible adult patients aged 65 years or older undergoing elective cardiac surgery were randomly allocated in a 1:1 ratio to either the dexmedetomidine group or the placebo group on the day of surgery. Infusion of dexmedetomidine or matched placebo commenced on the night following surgery (8 pm- 8 am) and continued nightly while the patient remained in the ICU or for a maximum of 7 days. The primary endpoint assessed was the incidence of PoD within 7 days post-surgery.
The results showed that 348 patients provided informed consent, 333 were randomized, and 331 underwent surgery and subsequent analysis (165 were assigned to dexmedetomidine, and 166 were assigned to placebo). The incidence of PoD did not exhibit a significant difference between the two groups (12.6% vs. 12.4%, P=0.97). Patients treated with dexmedetomidine experienced significantly more hypotensive events compared to those on placebo (7.3% vs. 0.6%; P<0.01). At the 3-month mark, functional outcomes assessed through measures (Short-form 36, Cognitive Failure Questionnaire, and PCL-5) were comparable between the two groups.
Investigators concluded that overnight dexmedetomidine infusion in elective cardiac surgery patients showed no effect in reducing PoD.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04842-1