Pharmacy to Dose: The Critical Care Podcast Dexmedetomidine ICU Clinical Pearls
Oct 17, 2025
Natalia Smith, a critical care pharmacist transitioning to an ICU role, shares insights on using dexmedetomidine to improve sleep in the ICU. She discusses its mechanism, potential benefits for sleep architecture, and practical dosing strategies. Alyson DeRosa, a PGY2 resident, explores dexmedetomidine's role in managing alcohol withdrawal syndrome, emphasizing its limitations and safety concerns. Together, they highlight the importance of combining dexmedetomidine with traditional therapies while monitoring for adverse effects.
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ICU Sleep Architecture Is Severely Disrupted
- ICU patients have fragmented sleep with reduced deep NREM (N2/N3) and REM stages on polysomnography.
- This dysregulation links to delirium, immune and cognitive dysfunction, and long-term PTSD and mood disorders.
Dexmedetomidine Targets Wakefulness Pathways
- Dexmedetomidine reduces norepinephrine release in the CNS by alpha-2 agonism, targeting wake-promoting pathways.
- Studies show improved total sleep time and N2 sleep but minimal effect on N3 (deep) and REM sleep.
Evidence Improves Architecture But Lacks Clinical Outcomes
- Systematic review of 12 RCTs (mostly surgical) found increased sleep efficiency and N2 duration with dexmedetomidine.
- Subjective sleep improvements were mixed and long-term clinical outcomes were not demonstrated.