Objective:
Management of pain, agitation and delirium (PAD) remains to be a true challenge in critically ill patients. The pharmacological proprieties of dexmedetomidine (DEX) make it an ideal candidate drug for light and cooperative sedation, but many practical questions remain unanswered. This structured consensus from 17 intensivists well experienced on PAD management and DEX use provides
indications for the appropriate use of DEX in clinical practice.
Methods:
A modified RAND/UCLA appropriateness method was used. In four predefined patient populations, the clinical scenarios do
not properly cope by the current recommended pharmacological strategies (except DEX), and the possible advantages of DEX use were
identified and voted for agreement, after reviewing literature data.
Results:
Three scenarios in medical patients, five scenarios in patients with acute respiratory failure undergoing non-invasive ventilation,
three scenarios in patients with cardiac surgery in the early postoperative period and three scenarios in patients with overt delirium were
identified as challenging with the current PAD strategies. In these scenarios, the use of DEX was voted as potentially useful by most of the
panellists owing to its specific pharmacological characteristics, such as conservation of cognitive function, lack of effects on the respiratory
drive, low induction of delirium and analgesia effects.
Conclusion:
DEX might be considered as a first-line sedative in different scenarios even though conclusive data on its benefits are still
lacking.
Keywords: Sedation, delirium, analgesia, intensive care, critically ill patients