Nocturnal Low-Dose Propofol Infusion for the Management of ICU Delirium: A Case Series in Nonintubated Cardiac Surgery Patients.

Abstract

DELIRIUM IS A COMMON problem in critically ill patients. 1 Ouimet S. Kavanaugh B.P. Gottfried S.B. et al. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med. 2007; 33: 66-73 Crossref PubMed Scopus (708) Google Scholar Patients with dementia; a history of hypertension; alcoholism; and severe illness are at higher risk of developing delirium; medication such as benzodiazepines also have been implicated in increasing the risk of delirium. 2 Barr J. Fraser G.L. Puntillo K. et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41: 263-306 Crossref PubMed Scopus (2471) Google Scholar Delirium is associated with increased short-term and long-term morbidity and mortality. 3 Milbrandt E.B. Deppen S. Harrison P.L. et al. Costs associated with delirium in mechanically ventilated patients. Crit Care Med. 2004; 32: 955-962 Crossref PubMed Scopus (623) Google Scholar , 4 Pandharipande P.P. Girard T.D. Jackson J.C. et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013; 369: 1306-1316 Crossref PubMed Scopus (1561) Google Scholar In patients who require sedation, the α2-adrenergic receptor agonist dexmedetomidine appears to be associated with the least amount of delirium. 5 Maldonado J.R. Wysong A. van der Starre P.J. et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics. 2009; 50: 206-217 Abstract Full Text Full Text PDF PubMed Scopus (331) Google Scholar , 6 Jakob S.M. Ruokonen E. Grounds R.M. et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: Two randomized controlled trials. JAMA. 2012; 307: 1151-1160 Crossref PubMed Scopus (628) Google Scholar However, treating delirium remains a challenge. Beyond nonpharmacologic interventions and treating underlying causes, limited pharmacologic options exist. Typical and atypical antipsychotics and dexmedetomidine often are used despite the lack of evidence of their efficacy. 2 Barr J. Fraser G.L. Puntillo K. et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41: 263-306 Crossref PubMed Scopus (2471) Google Scholar