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

Yang Long; Long-Zhen Liu; Xiao-Xue Tan; Yong-Hu Zhang; Cheng-Xi Liu; Shan Liu; Wen-Jie Liu

doi:10.1002/ibra.70015

Ibrain ›› 2026, Vol. 12 ›› Issue (1) :137–150 DOI: 10.1002/ibra.70015

ORIGINAL ARTICLE

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

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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.

Keywords

early dexmedetomidine administration / MIMIC-IV / survival outcomes / traumatic brain injury

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Yang Long, Long-Zhen Liu, Xiao-Xue Tan, Yong-Hu Zhang, Cheng-Xi Liu, Shan Liu, Wen-Jie Liu. 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. Ibrain, 2026, 12 (1) : 137–150 DOI:10.1002/ibra.70015

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