Impact of early dexmedetomidine administration on short- and long-term outcomes in critically traumatic brain injury patients: A retrospective study using the MIMIC-IV database

Abstract

Traumatic brain injury (TBI) causes significant mortality. Dexmedetomidine (DEX) shows neuroprotective potential in animals, but clinical evidence remains inconsistent. We evaluated the impact of early DEX, initiated within 48 h of admission with a treatment duration of at least 4 h, on survival in intensive care unit (ICU) patients with TBI using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Outcomes included 28-day, hospital, and 1-year mortality, analyzed via propensity score matching (PSM), multivariable Cox models, and subgroup analyses. Of 2378 patients, 241 received DEX. After PSM (235 pairs), early DEX use significantly reduced 28-day (HR 0.45, 95% CI 0.30–0.69, p < 0.001) and hospital mortality (HR 0.25, 95% CI 0.15–0.42, p < 0.001). These results remained robust across sensitivity analyses. Similarly, 1-year mortality decreased (HR 0.64, 95% CI 0.47–0.87, p < 0.01) and further supported by the Boruta algorithm, although inverse probability of treatment weighting analysis showed only a non-significant trend (p = 0.08). Survival benefits were more pronounced in patients aged <65 and those requiring mechanical ventilation. In conclusion, early DEX use is associated with improved short- and long-term survival in ICU patients with TBI, particularly in younger individuals and those requiring mechanical ventilation. Randomized controlled trials are warranted to establish causality.