Dexmedetomidine Effect on Agitated Psychotic Patients Suffer COPD: A Case Control Study

Wfa, Mohamed Zakarea; El-Ahwal, Laila Ahmed Abd-Elmotaleb; Abogabal, Marwa Ahmed

doi:10.21608/egja.2025.371482.1042

Dexmedetomidine Effect on Agitated Psychotic Patients Suffer COPD: A Case Control Study

Document Type : Original Article

Authors

¹ Lecturer of Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.

² Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

³ Anesthesiology, Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

10.21608/egja.2025.371482.1042

Abstract

Background: Mood disorders, neurodegenerative diseases, psychotic disorders, and other mental health issues can cause acute agitation. In extreme cases of agitation, dexmedetomidine might be an effective rescue medication. This work aimed to assess the effectiveness of dexmedetomidine in managing agitation among psychotic patients with severe, acute exacerbations of chronic obstructive pulmonary disease (COPD) caused by chest infections and necessitating non-invasive ventilation (NIV).
Methods: This case-control study involved 70 patients aged >35 years old, both sexes, came to an intensive care unit with exacerbated COPD patients and suffered delirium and agitation. Patients were divided into two equal groups: Group I (control group): non-psychotic cases and Group II (case group): psychotic cases (schizophrenia and bipolar disorders) on medical treatment.
Results: There was a significant increase in the failure rate of weaning off NIV in group II than in group I (P < 0.001). Regarding Richmond agitation score, patients were more sedated in group I than group II (P= 0.015). Group I had a significant decrease in the effective doses of dexmedetomidine to control agitation than Group II (P < 0.001).
Conclusions: Dexmedetomidine is the drug of choice to control agitation due to hypoxia and hypercarbia in patients with exaggerated COPD, while it had limited effect on psychotic patients who were on antipsychotic drugs and suffered exaggerated COPD, and this may be due the degree of agitation was severe due to combined factors; the disease of psychosis itself and the effect of hypoxia and hypercarbia.

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