| Association of dexmedetomidine with improved survival in ICU delirium |
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Yiwen Huang1, Lixia Zhu2, Yuechu Zhao3, Xiaofei Yan3, Qi Chen3, Ting Li3, Zhi Cao3, Hongbin Li3, Lingying Qu3, Kai Gao3, Xiaoxin Gao3, Boliu Liang1, Wenqiang Jiang3, Weifeng Li3, Bei Hu3 |
1Department of Emergency Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
2Qianhai Life Insurance (Guangzhou) General Hospital, Guangzhou, China
3Department of Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China |
Corresponding author:
Wenqiang Jiang,
Email: Primary corresponding author
Weifeng Li,
Email: liweifeng2736@gdph.org.cn
Bei Hu,
Email: hubei@gdph.org.cn
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Received: 27 November 2025 • Revised: 4 June 2026 • Accepted: 19 June 2026
*Yiwen Huang, Lixia Zhu and Yuechu Zhao contributed equally to this study as co-first authors. |
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| Abstract |
Background
Intensive care unit (ICU) delirium is common in critically ill patients and portends poor outcomes. Although dexmedetomidine (DEX) provides arousable sedation and possible neuroprotection, its survival benefit in established ICU delirium remains unclear. This study assessed the association between DEX initiation within 24 h of ICU admission and mortality in patients with early ICU delirium.
Methods
This retrospective cohort study used data from the Medical Information Market for Intensive Care IV database. ICU patients with a positive Confusion Assessment Method for the ICU screen on the first ICU day were included. The propensity score matching balanced baseline characteristics and interventions between the DEX and non-DEX groups. Kaplan-Meier and Cox regression analyses were used to assess ICU mortality, 30-day and 90-day all-cause mortality post ICU admission, together with the dose-response correlations with average daily DEX dose.
Results
Among 7,441 eligible patients, matching yielded 2,596 patients, with 1,298 in each group. Mortality was lower in the DEX group than in the non-DEX group (13.33% vs. 18.18%, P = 0.001). Kaplan-Meier analysis showed better 30-day and 90-day survival in the DEX group.Fully adjusted Cox modeling showed DEX use associated with improved survival. (HR 0.67; 95%CI: 0.54-0.82; P < 0.001). This survival advantage persisted across subgroups and showed a dose–response pattern, with a higher daily DEX dose linked to better 30-day and 90-day survival.
Conclusions
Early DEX administration was associated with improved short- and long-term survival in ICU patients with delirium. Prospective randomized trials are warranted. |
| Key Words:
Delirium; Dexmedetomidine; Intensive care units; Mortality; MIMIC-IV; Propensity Score |
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