Objective: Sedation in the intensive care unit plays a key role in patient management as it helps suppress agitation, increases tolerance to stress, and facilitates medical interventions, such as noninvasive ventilation (NIV) Our purpose was to determine the long-term hemodynamic effects of dexmedetomidine in elderly patients with acute respiratory failure who require NIV. Methods: We recorded the data concerning age, comorbidities, doses of dexmedetomidine, hemodynamic parameters, use of vasopressors and length of ICU stay, from the hospital electronic medical recor system Due to the possibility of causing hemodynamic instability in ICU, patients with reduced ventricular contractility, hypothermia, septic shock, endocrine pathologies and neurosurgery cases, were excluded from the study. Results: The patients were evaluated in four age groups: Group I: 18-39 years; Group II, 40-64 years; Group III, 65-80 years, and Group IV, aged >80 years The patients in group IV were found to be at a higher risk for a decrease in MAP following onset of dexmedetomidine treatment (p=0.005*). Notably, most of the vasoactive agents were used in patients over 85 years old (54.2%, p=0.005). With increasing age hypotension and vasopressor needs were found to exhibit a corresponding augmentation. Conclusion: Dexmedetomidine meets requirements for sedation during NIV in the ICU. Even without loading dose the drug can induce hemodynamic instability, therefore close monitoring is necessary. In elderly, dexmedetomidine should be started at the lowest possible dose and slowly titrated according to the patient’s response.