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Nocturnal Precedex Administration Preventing ICU-Associated Delirium

Sara R. Yoder

School of Nursing, James Madison University

NSG 464: Introduction to Nursing Research

April 23, 2023

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Abstract

Among Intensive Care Unit patients, administering nocturnal Precedex (Dexmedetomidine) to

patients who are at high risk for confusion and altered mental status will help prevent ICU-

associated delirium. In the Intensive Care Unit, the average age group is older adults, over 60

years old. The problem behind this question is that there is a greater risk of delirium patients will

acquire while being in a hospital setting (Skrobik, 2018). As a patient, whom is already sick in an

unfamiliar environment; it is harder to get a good night's sleep because they are uncomfortable

not being in their own home. Another factor is healthcare providers continuously entering and

leaving the patient’s room day and night, the patient gets minimal chances to get a long,

uninterrupted sleep. Precedex infusion allows adequate sedation levels but also conserves

rearousability and cognitive brain functions. By initiating nocturnal Precedex, this prevents

delirium and improves sleep in critically ill patients.

Keywords: Patient, Precedex, Delirium, Intensive Care Unit

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Nocturnal Precedex Administration Preventing ICU-associated Delirium

Among Intensive Care Unit patients, administering nocturnal Precedex

(Dexmedetomidine) to patients at high risk for confusion and altered mental status will help

prevent ICU-associated delirium. In the Intensive Care Unit, the average age group is older

adults, 60 years and older. As a patient, it is harder to get a good night's sleep because they are

uncomfortable being in an unfamiliar environment. Another factor is healthcare providers

continuously entering and leaving the patient’s room day and night, the patient gets minimal

chances to get a long, uninterrupted sleep. Nocturnal Precedex will prevent and treat ICU-

associated delirium in the older adult population compared to other pharmacological

interventions including Midazolam, Haldol or Benzodiazepines. Initiating Precedex in the

evening time until the early morning will help promote restless sleep and a shorter ICU stay for

the patient.

Delirium in the ICU

Delirium during an ICU admission has proven to have significant long-term impact on

cognitive function after ICU discharge (McLaughlin, 2016). There are many risk factors for

developing delirium that can occur in ICU patients including fever, sepsis, vasopressor

requirements and the use of medications such as analgesia. Due to the significance that delirium

has in the ICU, new strategies to both prevent and treat delirium in the ICU are needed to address

this complication and improve long-term outcomes in ICU patients. Early detection is important,

and an effective screening tool for nurses is crucial. The Delirium Observation Screening (DOS)

scale is one screening tool used to evaluate the potential of a patient being delirious (Park, 2021).

By using this tool, healthcare providers can establish non-pharmacological and pharmacological

solutions to reducing ICU-associated delirium.

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Precedex Usage

With the lack of sleep, there is less healing in the body and more likely for delirium to

occur due to the body’s dysregulation. Precedex has been shown to inhibit the release of

norepinephrine in the locus ceruleus and has enhanced slow wave sleep by mimicking the

NREM sleep pathway (Oto, 2012). There are other medications in the ICU used to promote

sedative effects, however, Precedex infusion allows adequate sedation levels but also conserves

rearousability and cognitive brain functions. The patient should be able to improve their health

while in the hospital instead of digress. Precedex could be the medication of choice to treat

delirious patients due to specific properties: absence of excessive sedation, easy titration, fewer

side effects than neuroleptics and rare interactions with other drugs (Louis, 2018). If Precedex

can improve the sleep cycle and reduce delirium, then a patient would have a shorter, more

efficient stay in the ICU. By initiating nocturnal Precedex, this prevents delirium and improves

sleep in critically ill patients. Precedex will be used in low doses starting in the evening hours to

establish effective sleep during the night then turning the medication off in the morning hours. In

a study, Dexmedetomidine was ranked most effective in reducing delirium duration, followed by

atypical antipsychotics (Burry, 2019).

Non-pharmacological Intervention

In addition to a Precedex infusion for a patient with high risk delirium in the ICU, non-

pharmacological interventions have been used to decrease the chances. The patient’s family is an

important part of delirium prevention and should be involved in the therapeutic process. An

additional benefit of including the family is to improve the families’ perceptions of the work of

the medical staff (Lange, 2022). By having patient-centered care, this involves having not only

different medical staff engaged in patient care but also the patient’s family members to make the
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hospital stay less stressful for the patient. If a family member can be a familiar face to the

patient, then there can be less risk of delirium if there are recognizable things and daily routine.

The most essential aspect of patient-centered care for delirium is risk minimization and

prevention. Healthcare providers should advocate early on in patient care and implement

delirium assessment practices and interventions to minimize the risk of delirium in intensive care

unit patients.

Nursing Interventions

As an ICU nurse, this job requires one to first establish a good rapport with the patient

and make sure they are comfortable with the care being received. This job requires continuous

close monitoring of the patient and hourly rounding checks. A nurse is dictated to follow

medication orders, specifically for Precedex, and titrate the medication as prescribed. With

Precedex, side effects can include bradycardia, hypotension and lethargy (Ungarian, 2019). It is

necessary as the primary nurse to watch for contraindications. Other goals include orienting the

patient to the place, time and who is coming into the room everytime walking in. Using daily

screening tools to identify delirium can help the healthcare providers prevent and treat delirium

early before it impacts the patient’s care and health in the hospital.

Conclusion

The use of Precedex as a pharmacological intervention to ICU-associated delirium has

shown to prevent and treat patient’s delirium. Precedex should be a first line medication choice

for delirious patients due to specific properties: absence of excessive sedation, easy titration,

fewer side effects than neuroleptics and rare interactions with other drugs (Louis, 2018).

Delirium occurrence is frequent due to environment changes, unfamiliar faces and heightened

illness. This increases patients’ short- and long-term morbidity and mortality (Louis, 2018).
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Adding Precedex to high risk delirium patients will decrease the length of their ICU admission

because their care will be more effective and less adverse effects from being in the hospital.
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