Introduction: Nocturnal hyperactive delirium in non-intubated critically ill patients in high-dependency units (HDUs) is challenging due to limited use of sedatives and lack of human resources, which may increase nursing workload. We hypothesized that dexmedetomidine (DEX) would reduce nursing burden compared to haloperidol (HD) by achieving more effective sedation. Methods: We performed a subanalysis of the DEX-HD trial, which compared DEX and HD for sedation of nocturnal hyperactive delirium in non-intubated critically ill patients who were emergently admitted to two HDUs of a tertiary care hospital, where the nurse-to-patient ratio is 1:4. Nursing workload of up to two nurses was assessed using two approaches: (1) Bedside care time during the 8 hours following the start of the study drug administration was measured using two tabletop stopwatches placed at the entrance of each patient’s room, allowing simultaneous measurement per patient. (2) Post-night shift questionnaires were administered per patient (primary and secondary night-shift nurses), evaluating absence of overtime, perceived fatigue, and adequacy of break time. Results: A total of 166 nurses cared for 99 patients assigned to DEX or HD (DEX: 52, HD: 47), covering 99 primary and 67 secondary nurse shifts; responses were available from 88 in the DEX group and 78 in the HD group. In several cases, only one nurse responded due to single-person coverage. Bedside care time was significantly shorter in the DEX group (median 71 IQR 45–100 vs 92 IQR 60–162 minutes; P = 0.038). A greater proportion of nurses caring for patients assigned to DEX experienced no overtime, compared to HD (20.2% vs 46.2%; P < 0.001). The prevalence of perceived fatigue (85.2% vs 93.6%; P = 0.084) and fully acquiring break (70.5% vs 58.9%; P = 0.12) did not differ statistically. Conclusions: DEX was associated with a reduction in nursing workload in HDUs by shortening bedside care time and decreasing overtime, although it was not associated with improvement in perceived fatigue or break time acquisition. These results suggest the consideration of DEX as a preferred sedative for nocturnal hyperactive delirium in HDUs, where staffing constraints are more pronounced.
Minami et al. (Sun,) studied this question.