Original Article

Experienced Use of Dexmedetomidine in the Intensive Care Unit: A Report of a Structured Consensus


  • Daniela Pasero
  • Fabio Sangalli
  • Massimo Baiocchi
  • laria Blangetti
  • Sergio Cattane
  • Gianluca Paternoster
  • Marco Moltrasio
  • Elisabetta Auci
  • Patrizia Murrino
  • Francesco Forfori
  • Ester Forastiere
  • Maria Giovanna De Cristofaro
  • Giorgio Deste
  • Paolo Feltracco
  • Flavia Petrini
  • Luigi Tritapepe
  • Massimo Girardis

Received Date: 06.02.2018 Accepted Date: 28.05.2018 Turk J Anaesthesiol Reanim 2018;46(3):176-183


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.


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.


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.


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