Management of an Autism Spectrum Disorder (ASD) Patient With Respiratory Failure in the Intensive Care Unit: A Case Report on the Role of Dexmedetomidine

This clinical case describes the management, in an intensive care unit (ICU), of a patient with a severe form of autism spectrum disorder (ASD) Level 3, suffering from acute respiratory failure that evolved into acute respiratory distress syndrome (ARDS). Throughout the entire period of hospitalisation in the ICU, sedation of the patient played a key role in the performance of all invasive and noninvasive therapeutic procedures, in particular artificial ventilation and subsequent weaning, due to the underlying disorder that rendered the patient completely uncooperative. Dexmedetomidine was used during initial admission to the ICU for initial treatment, during the period of artificial ventilation and finally during weaning from mechanical ventilation. The α2 agonist, due to its pharmacodynamic and pharmacokinetic characteristics, also facilitated the overlap with home antipsychotic drugs upon both discontinuation and reinstatement, allowing discharge from the ICU and safe and serene home management of the tracheostomy until its closure.