Efficacy and Safety of Dexmedetomidine in the Prevention of Delirium in Intensive Care Units and Critically-Ill Old Adult Patients: A Systematic Review

Background/Objectives: Delirium is an acute state of confusion associated with impaired consciousness and a decline in cognitive function. Delirium has significant clinical importance due to its substantial impact on morbidity and mortality. The primary objective of this systematic review is to assess Dexmedetomidine’s potential efficacy for delirium in critically ill and elderly patients, addressing a significant need in this high-risk population, and to evaluate its safety as a secondary objective. Methods: A systematic review (2018–2024) searched PubMed, Embase, and Cochrane for English-language studies on dexmedetomidine and delirium in older intensive care unit (ICU) patients. Dual reviewers independently screened, extracted data, and resolved disagreements. Eligible randamized control trials (RCTs) and observational studies were assessed using Risk of Bias 2 ( RoB-2) and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tools. Results: Dexmedetomidine emerges as a promising drug because of its unique pharmacological profile, which provides sedation without modulating gamma-aminobutyric acid (GABA) receptors, potentially lowering the risk of delirium. Its additional analgesic, anti-inflammatory, and organ-protective characteristics could provide broader clinical benefits in the ICU. However, the aged population’s heightened susceptibility to Dexmedetomidine’s hemodynamic effects may limit some of its potential benefits. Conclusions: Although existing research suggests short-term neuroprotective effects, these effects do not always translate into better long-term survival. As a result, further large-scale, well-designed randomized controlled trials are needed to determine the optimal use of Dexmedetomidine in this population and to understand its overall impact on morbidity and mortality in the ICU.