Patient-targeted light sedation in the Intensive Care Unit: are we ready for precision medicine with dexmedetomidine?

Sedation is a universal component of care for critically ill patients. Recognition of the consistent link between deep sedation and adverse outcomes (nosocomial infections, delirium, duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality) has led, during the last decade, to a novel approach aiming to maintain patients in a pain-free and cooperative state, However, deep sedation is still common in ICU. One main reason is the due to the pharmacokinetics and pharmacodynamics (PK/PD) determinants of sedative drugs. Dexmedetomidine is the first sedative drug introduced in Europe for long-term ICU sedation providing relevant benefits such as reduction of duration of mechanical ventilation, of time to extubation. These benefits may result from the unique PK/PD of the drug. Moreover, additional benefits of dexmedetomidine, not closely linked to its sedative effects, include its neuro-protective effect in brain injury, its renal and myocardial protective effect in cardiac surgery and the lack of deleterious effects on innate immune response. However, a large knowledge gap remains, and we are still far from being able to apply precision medicine to light sedation with dexmedetomidine in ICU.