RecentRCT

4D

Dexmedetomidine for treatment of hyperactive delirium in non-intubated ICU patients: the 4D randomized clinical trial.

Intensive care medicine, 2025 · Multicenter randomized trial

Population: 151 nonintubated ICU adults with hyperactive delirium
Intervention: Dexmedetomidine
Comparator: Placebo
Primary outcome: Joint-model composite of agitation/delirium duration and intubation/deep sedation
Result: Composite favored dexmedetomidine; median agitation 1 versus 2 hours. Other key secondary outcomes were similar. Stopped at planned interim efficacy analysis.

What the trial found

Composite favored dexmedetomidine; median agitation 1 versus 2 hours. Other key secondary outcomes were similar. Stopped at planned interim efficacy analysis.

Clinical interpretation

Selected monitored hyperactive-delirium population; does not establish an isolated mortality/intubation benefit or routine use in all delirium.

Moderate certainty

Clinical Context & Relevant Topics (2)

Disease Reference

Antipsychotics in the ICU

Safe ICU use of antipsychotics: delirium evidence, agitation control, QTc/torsades risk, NMS, EPS, interactions, and deprescribing.

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ICU Sedation, Analgesia, Delirium & Liberation

Analgesia-first sedation, light sedation targets, ABCDEF bundle, spontaneous breathing trials, and non-pharmacologic delirium mitigation.

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