Treatment Of Delirium In Intensive Care Unit Research Articles

Nonpharmacologic and Medication Minimization Strategies for the Prevention and Treatment of ICU Delirium: A Narrative Review.

Delirium is a multifactorial entity, and its understanding continues to evolve. Delirium has been associated with increased morbidity, mortality, length of stay, and cost for hospitalized patients, especially for patients in the intensive care unit (ICU). Recent literature on delirium focuses on specific pharmacologic risk factors and pharmacologic interventions to minimize course and severity of delirium. While medication management clearly plays a role in delirium management, there are a variety of nonpharmacologic interventions, pharmacologic minimization strategies, and protocols that have been recently described. A PubMed search was performed to review the evidence for nonpharmacologic management, pharmacologic minimization strategies, and prevention of delirium for patients in the ICU. Recent approaches were condensed into 10 actionable steps to manage delirium and minimize medications for ICU patients and are presented in this review.

Antipsychotics, Delirium, and Acute Respiratory Distress Syndrome: What Is the Link?

Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, and they experience long-term cognitive impairment and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidity and mortality. Antipsychotics are prescribed to decrease the severity and duration of ICU delirium, thus potentially decreasing their risk of morbidity and mortality. However, antipsychotics are associated with many adverse effects including respiratory failure. Given the long-term sequelae associated with the development of ICU delirium and the risks associated with antipsychotic use, clinicians must weigh the risks and benefits of antipsychotic use. This review investigates the interrelationship between ARDS, delirium, and antipsychotic use. In addition to discussing relevant studies evaluating antipsychotics for the prevention and treatment of delirium, we investigate safety concerns with the use of antipsychotics, especially as they relate to ARDS. Using the data compiled in this review, clinicians can make an informed decision about the use of antipsychotics for the prevention or treatment of delirium, with special consideration for their patients with ARDS. Future studies are needed to critically evaluate antipsychotic timing, dose, and duration for the prevention and treatment of ICU delirium and specifically evaluate the impact in special populations, particularly patients with ARDS.

A retrospective analysis of the effectiveness of antipsychotics in the treatment of ICU delirium

PurposeConflicting data exists on the efficacy of antipsychotics for treatment of intensive care unit (ICU) delirium. The purpose of this study was to compare time to delirium resolution for ICU patients who were managed with and without antipsychotics. Materials and methodsThis retrospective cohort evaluation included patients admitted to 12 ICUs at 5 sites over 5 weeks diagnosed with delirium. The primary outcome was time to delirium resolution. Secondary outcomes included ICU length of stay (LOS), mortality, discharge disposition and delirium redevelopment. A Cox proportional hazards model explored the relationship between covariates including antipsychotics and time to delirium resolution. ResultsA total of 255 patients met inclusion criteria; 69 (27%) received antipsychotics. In the antipsychotic group, time to resolution of delirium was longer (Median: 36hours vs. 13hours, p<0.001) and ICU LOS was longer (Median: 5.9days vs. 3.8days, p=0.005), but there were no differences in mortality or discharge disposition. Patients who used antipsychotics (HR=0.512; 95% CI: 0.276–0.952) and received mechanical ventilation (HR=0.381; 95% CI: 0.217–0.669) had slower rate for time to delirium resolution. ConclusionsWhile the treatment of delirium with antipsychotics remains common, antipsychotics were not associated with a shorter time to resolution of delirium.

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Introduction: to compare the cost-effectiveness of the oral second generation anti psychotic medication Quetiapine with that of the intravenous centrally acting sedative Dexmedetomidine in the treatment of intensive care unit (ICU) delirium. We hypothesized that Quetiapine, when the oral route is accessible, is as effective as Dexmedetomidine in the treatment of ICU delirium, and is cheaper. Methods: In a single center retrospective medical record review, a total of 70 patients diagnosed with ICU delirium through the Confusion Assessment Method (CAM-ICU) scale between July 1,2010 and December 31,2012 and treated with either Quetiapine per os (35 patients) or intravenous Dexmedetomidine (35 patients), plus or minus Haldol, were included. The cost was assessed directly via the drug cost to pharmacy, the efficacy was related to resolution of delirium, ICU and hospital length of stay (LOS). Results: Deidentified data were collected on demographics, admission diagnosis, Acute Physiology and Chronic Health Evaluation II score, chronic health conditions, ICU and hospital LOS, ventilation duration, use of benzodiazepine drugs, outcome, and cost of the studied drugs. Baseline characteristics were similar between the 2 groups, the admission diagnosis did not differ significantly. The average dose of Dexmedetomidine was 0.92 mcg/kg/hr (0.2–1.5) v/s 65 mg/day (25–200) for Quetiapine. Haldol was used equally (5 patients in each group, average of 20 mg/patient); the Quetiapine group spent less days in the ICU and the hospital but the difference did not reach statistical significance (8.32 (2–35) v/s 11.35 (3–43), p=0.11) and 12.08 (4–35) v/s 14.67 (3–43), p=0.12 respectively). The days spent on the ventilator did not reach statistical significance (7.6 (1–35) for the Dexmedetomidine group v/s 4.6 (1–18), p=0.57). benzodiazepine drips or PRN doses were not used in any of the groups. 4 Patients expired in the Dexmedetomidine group v/s 7 in the other group (p=0.3). The delirium resolved in all the patients with a mean of 2.67 days (1–21) in the Dexmedetomidine group and 3.14 days (1–10) in the Quetiapine group (p=0.23). Quetiapine was used on an average of 6.35 days (1–25) v/s 2.94 (1–6) days for Dexmedetomidine. Dexmedetomidine average cost to pharmacy was 2013 USD per patient v/s 4.625 USD per patient for Quetiapine. Conclusions: Quetiapine is as effective as dexmedetomidine in treating ICU delirium and is at least 435 times less expensive.

Dexmedetomidine in the prevention and treatment of delirium in critically ill patients

Background The incidence of delirium in the critically ill patients is high, which could increase the incidence of complications and mortality rate. Dexmedetomidine is a relatively new agent used in intensive care unit (ICU), with satisfactory sedative and analgesic properties. Clinical trials have proved its advantages on prevention and control of delirium in ICU. Objective Our current article reviewed the effect of dexmedetomidine on prevention and treatment of delirium in ICU. Content This article described the epidemiology and risk factors of delirium, pharmacological characteristics of dexmedetomidine,mechanism for its prevention and treatment of delirium,and application strategy of dexmedetomidine in prevention and control of delirium in ICU. Trend Dexmedetomidine can effectively prevent and control the occurrence of delirium in critically ill patients. However, further studies are warranted to evalauate its effectiveness and safety for delirium prevention or management in ICU. Key words: Dexmedetomidine ; Delirium ; Intensive care unit ;

Delirium in the Intensive Care Unit: Medications as Risk Factors

Delirium in the Intensive Care Unit: Medications as Risk Factors

Delirium in the intensive care unit

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients, occurring in up to 80% of the sickest intensive care unit (ICU) populations. Critically ill patients are subject to numerous risk factors for delirium. Some of these, such as exposure to sedative and analgesic medications, may be modified to reduce risk. Although dysfunction of other organ systems continues to receive more clinical attention, delirium is now recognized to be a significant contributor to morbidity and mortality in the ICU, and it is recommended that all ICU patients be monitored using a validated delirium assessment instrument. Patients with delirium have longer hospital stays and lower 6-month survival than do patients without delirium, and preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge. Little evidence exists regarding the prevention and treatment of delirium in the ICU, but multicomponent interventions reduce the incidence of delirium in non-ICU studies. Strategies for the prevention and treatment of ICU delirium are the subjects of multiple ongoing investigations.