824: THE EFFECT OF DEXMEDETOMIDINE ON DELIRIUM IN TRAUMA ICU PATIENTS

Abstract

Introduction: Delirium is an acute disturbance in attention and cognition that develops over a short period of time. It is the most common complication afflicting patients admitted to the ICU. Despite the numerous scores developed to detect delirium such as CAM-ICU and RASS scales, delirium is still often misdiagnosed. Sedation in intensive care setting aims to keep the patient calm, cooperative, and able to communicate their needs. Literature showed that dexmedetomidine has a different pattern of sedation and favorable effects on delirium in non-trauma patients. This study aims to determine if dexmedetomidine may prevent delirium in trauma ICU patients. Methods: This was a retrospective cohort study of patients admitted to Charleston Area Medical Center’s (CAMC) Surgical/Trauma ICU (STICU) between January 1, 2017 and December 31, 2021. Patients with a traumatic injury above the age of 18 under sedation in the STICU were dichotomized into patients receiving dexmedetomidine and those receiving other sedative agents. The primary objective was rate of delirium. Secondary objectives included evaluation of hemodynamic stability, ICU length of stay, and hospital length of stay. Results: A total of 273 patients were evaluated with 163 in the dexmedetomidine group and 110 in the non-dexmedetomidine group. No difference in baseline characteristics were observed including home antipsychotic and antidepressant use. The primary outcome was similar between groups with delirium rates being 17 (10.4%) patients in the dexmedetomidine group vs 14 (12.7%) in the non-dexmedetomidine group. Individual risk factors for delirium included pre-existing psychiatric illness (OR = 2.83, 95% CI 1.19-6.74, p = 0.01) and benzodiazepine exposure (OR = 3.14, 95% CI 1.12-8.78, p=0.02). No difference in secondary outcomes were observed. Conclusions: Our study showed no difference in delirium between patients that received dexmedetomidine vs those that received other agents. Results on independent risk factors were consistent with previously reported literature, which supports existing evidence that delirium risk has both modifiable and non-modifiable factors. However, this adds to the growing literature that choosing dexmedetomidine may have less impact on decreasing delirium compared to appropriate assessment and targeting light sedation.