Abstract
Delirium is one of the most frequently reported neuropsychiatric complications in the perioperative period, especially in the population of elderly patients who often suffer from numerous comorbidities undergoing extensive or urgent surgery. It can affect up to 80% of patients who require hospitalization in an intensive care setting postoperatively. Delirium increases mortality, morbidity, length of hospital stay, and cost of treatment. An episode of delirium in the acute phase may lower the general quality of life and increases the risk of cognitive decline long-term. Since pharmacological treatment of delirium is not highly effective, focus of research has shifted towards developing preventive strategies. We aimed to perform a review of the topic based on the most recent literature. We conclude that, based on the available data, it seems impossible to make strong recommendations for using antipsychotic drugs in prophylaxis. Further research should answer the question what, if any, benefit patients receive from the pharmacological prevention of delirium, and which agents should be used.
Highlights
Delirium is a set of neuropsychiatric symptoms, including qualitative disturbances of consciousness and attention, which may be accompanied by cognitive deficits and psychotic symptoms [1]
The incidence of delirium varies from several percent in patients hospitalized in general wards up to 80% in patients with multi-organ failure treated in intensive care units (ICU) [4,5]
Such pharmacological prophylaxis reduced the incidence of delirium in the first 7 days of hospitalization in the ICU (15.3% in the haloperidol group vs. 23.2% in the placebo group; RR = 0.66; 95% CI 0.45–0.97; p = 0.03)
Summary
Delirium is a set of neuropsychiatric symptoms, including qualitative disturbances of consciousness and attention, which may be accompanied by cognitive deficits and psychotic symptoms [1]. It is characterized by an acute onset with fluctuations of symptom intensity throughout the day, reaching its apogee usually in the evening and night [2]. Hypoactive delirium in the most frequent form, accounting for almost half of all delirium cases and may not be recognized even in 80% of patients, due to the coexistence of dementia or use of sedative drugs, which cannot always be discontinued in the ICU [6,7]. Screening for delirium may be more effective when using validated diagnostic scales: Confusion Assessment
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