A Pilot Study of the Use of Dexmedetomidine for the Control of Delirium by Reducing the Serum Concentrations of Brain-Derived Neurotrophic Factor, Neuron-Specific Enolase, and S100B in Polytrauma Patients

• Published in: Journal of intensive care medicine 2019-08, Vol.34 (8), p.674-681
• Main Authors: Li, Yong, Yu, Zhi-Xin, Ji, Mu-Sen, Yan, Jun, Cai, Yan, Liu, Jing, Yang, Hong-Feng, Jin, Zhao-Chen
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers - blood; Brain-Derived Neurotrophic Factor - blood; Delirium - blood; Delirium - diagnosis; Delirium - etiology; Delirium - prevention & control; Dexmedetomidine - therapeutic use; Female; Humans; Hypnotics and Sedatives - therapeutic use; Kaplan-Meier Estimate; Male; Middle Aged; Multiple Trauma - complications; Phosphopyruvate Hydratase - blood; Pilot Projects; Prospective Studies; S100 Calcium Binding Protein beta Subunit - blood; Treatment Outcome; Young Adult
• ISSN: 0885-0666; 1525-1489
• DOI: 10.1177/0885066617710643

Background: Delirium is very common among patients with polytrauma, although no suitable means exist to feasibly reduce the incidence and duration of delirium in these patients. Recent reports have suggested that continuous intravenous (IV) infusions of dexmedetomidine, rather than benzodiazepine, be administered for sedation to reduce the duration of delirium in this population. However, serum neuron-specific enolase (NSE), S100 calcium binding protein B (S100B), and brain-derived neurotrophic factor (BDNF) levels have not yet been investigated in polytrauma patients who received sedation with dexmedetomidine rather than other conventional sedatives. The aim of this study was to assess the association of blood BDNF, NSE, and S100B with the occurrence of delirium among polytrauma patients who had been sedated with dexmedetomidine. Materials and Methods: Consecutive patients were randomly assigned to 1 of 2 treatment study groups, namely the “dexmedetomidine group” or the “common group.” This case–control study included 18 patients with delirium and 34 matched controls in a 63-bed general intensive care unit (ICU). Blood samples were collected from all patients upon ICU admission, on the day when delirium was diagnosed, and on days 3 and 5 following diagnosis. The serum levels of S100B, BDNF, and NSE were determined by enzyme-linked immunosorbent assay. The sedation levels and delirium were assessed using the Richmond Agitation and Sedation Scale and the Confusion Assessment Method for the ICU. Results: The median BDNF, NSE, and S100B concentrations were significantly lower in the dexmedetomidine group than in the common group on the day when delirium was diagnosed and on the third day after delirium was diagnosed. The rate of delirium was significantly lower in the dexmedetomidine group than in the common group. There were clear differences in the BDNF, NSE, and S100B levels between the 2 groups on the fifth day after delirium was diagnosed. Conclusions: Our randomized controlled study suggests that the sedation of polytrauma patients with dexmedetomidine could help reduce the serum BDNF, S100B, and NSE levels, which appear to be associated with the occurrence of delirium in the dexmedetomidine group.