Understanding and Improving Pharmacological Delirium Prevention in Critically Ill Trauma Patients

Abstract

Background: Delirium is common in critically ill trauma patients, yet there is no evidence-based standard of care sedation agent for this population. Objective: This thesis aims to expand knowledge around dexmedetomidine, a sedative that has demonstrated potential superiority in other clinical patient populations. Methods: We conducted a systematic review and network meta-analysis to compare the effectiveness of sedatives on delirium and associated patient outcomes. We conducted a health records review of sedated trauma patients at The Ottawa Hospital. We derived a simple mathematical model to demonstrate potential impact of dexmedetomidine on resources. Results: There was no statistical difference between sedatives in preventing delirium. Approximately 79% of critical trauma patients were sedated with propofol, 18% with propofol and dexmedetomidine, and 3 with dexmedetomidine. Increasing the proportion of patients receiving propofol with adjunct dexmedetomidine could improve the number of freed ICU bed-days. Conclusion: Dexmedetomidine could have potential benefits in improving outcomes for critically ill trauma patients.