Dexmedetomidine in Palestinian intensive care units: The first multicenter cross-sector survey of sedation practices, protocol gaps, and withdrawal challenges.

OBJECTIVE

Dexmedetomidine has emerged as an important sedative due to its ability to provide cooperative sedation while preserving respiratory drive. However, its clinical use may vary across healthcare systems, particularly in resource-limited settings. This study aimed to assess patterns of dexmedetomidine use, associated protocols, withdrawal experiences, and perceived barriers across different intensive care units in the Palestinian healthcare system.

METHODS

A multicenter cross-sectional survey was conducted between October 2025 and January 2026 in governmental, teaching, and private hospitals. Anesthesiologists, intensive care physicians, and nurses with ≥ 6 months of experience were invited to complete a structured questionnaire addressing sedation practices, dosing, monitoring, withdrawal, perceptions, and institutional protocols.

RESULTS

A total of 158 healthcare professionals participated (response rate 71.8%). Propofol (86.7%) and midazolam (70.9%) were the most commonly used sedatives, while dexmedetomidine was reported in 56.3% of intensive care units, predominantly as an adjunct (73.4%). Formal protocols were present in only 29.7% of units, and validated monitoring tools were used by 43.7%. Withdrawal symptoms were reported by 38.0% of respondents, most often after 48-72 hours of infusion. Significant sectoral differences were observed, with dexmedetomidine use reported in 55.1% of teaching hospitals and 43.8% of private hospitals, but only 1.1% of governmental hospitals (p < 0.001). Professional role also influenced practice. Fentanyl use was reported by 86.2% of ICU physicians, 66.7% of anesthesiologists, and 47.3% of nurses (p = 0.001). Cost was identified as a barrier by 46.2% of respondents, and inconsistent availability was reported by 43.7%, with both factors limiting routine use.

CONCLUSION

Limited protocols, inconsistent monitoring, and cost barriers hindered routine use of dexmedetomidine, while withdrawal was reported after prolonged infusions. These findings provide context-specific evidence to guide national guidelines, hospital protocols, and workforce training, with procurement and monitoring reforms as immediate priorities.