Limits...
Delirium in the ICU: an overview.

Cavallazzi R, Saad M, Marik PE - Ann Intensive Care (2012)

Bottom Line: Three subtypes have been recognized: hyperactive, hypoactive, and mixed.The CAM-ICU is the most widely studied and validated diagnostic instrument.However, the accuracy of this tool may be less than ideal without adequate training of the providers applying it.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Pulmonary and Critical Care, Eastern Virginia Medical School, Norfolk, VA, USA. marikpe@evms.edu.

ABSTRACT
Delirium is characterized by a disturbance of consciousness with accompanying change in cognition. Delirium typically manifests as a constellation of symptoms with an acute onset and a fluctuating course. Delirium is extremely common in the intensive care unit (ICU) especially amongst mechanically ventilated patients. Three subtypes have been recognized: hyperactive, hypoactive, and mixed. Delirium is frequently undiagnosed unless specific diagnostic instruments are used. The CAM-ICU is the most widely studied and validated diagnostic instrument. However, the accuracy of this tool may be less than ideal without adequate training of the providers applying it. The presence of delirium has important prognostic implications; in mechanically ventilated patients it is associated with a 2.5-fold increase in short-term mortality and a 3.2-fold increase in 6-month mortality. Nonpharmacological approaches, such as physical and occupational therapy, decrease the duration of delirium and should be encouraged. Pharmacological treatment for delirium traditionally includes haloperidol; however, more data for haloperidol are needed given the paucity of placebo-controlled trials testing its efficacy to treat delirium in the ICU. Second-generation antipsychotics have emerged as an alternative for the treatment of delirium, and they may have a better safety profile. Dexmedetomidine may prove to be a valuable adjunctive agent for patients with delirium in the ICU.

No MeSH data available.


Related in: MedlinePlus

Factors leading to delirium.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3539890&req=5

Figure 1: Factors leading to delirium.

Mentions: Different mechanisms have been proposed to explain the pathophysiology of delirium. However, these mechanisms are not mutually exclusive and it is likely that they often act in concert (Figure 1). One hypothesis postulates that decreased cholinergic activity may lead to delirium [13]. This hypothesis is supported by the observation that anticholinergic medication use is associated with increase in delirium symptoms [14] and that patients with delirium have higher serum anticholinergic activity compared with those without delirium [15].


Delirium in the ICU: an overview.

Cavallazzi R, Saad M, Marik PE - Ann Intensive Care (2012)

Factors leading to delirium.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539890&req=5

Figure 1: Factors leading to delirium.
Mentions: Different mechanisms have been proposed to explain the pathophysiology of delirium. However, these mechanisms are not mutually exclusive and it is likely that they often act in concert (Figure 1). One hypothesis postulates that decreased cholinergic activity may lead to delirium [13]. This hypothesis is supported by the observation that anticholinergic medication use is associated with increase in delirium symptoms [14] and that patients with delirium have higher serum anticholinergic activity compared with those without delirium [15].

Bottom Line: Three subtypes have been recognized: hyperactive, hypoactive, and mixed.The CAM-ICU is the most widely studied and validated diagnostic instrument.However, the accuracy of this tool may be less than ideal without adequate training of the providers applying it.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Pulmonary and Critical Care, Eastern Virginia Medical School, Norfolk, VA, USA. marikpe@evms.edu.

ABSTRACT
Delirium is characterized by a disturbance of consciousness with accompanying change in cognition. Delirium typically manifests as a constellation of symptoms with an acute onset and a fluctuating course. Delirium is extremely common in the intensive care unit (ICU) especially amongst mechanically ventilated patients. Three subtypes have been recognized: hyperactive, hypoactive, and mixed. Delirium is frequently undiagnosed unless specific diagnostic instruments are used. The CAM-ICU is the most widely studied and validated diagnostic instrument. However, the accuracy of this tool may be less than ideal without adequate training of the providers applying it. The presence of delirium has important prognostic implications; in mechanically ventilated patients it is associated with a 2.5-fold increase in short-term mortality and a 3.2-fold increase in 6-month mortality. Nonpharmacological approaches, such as physical and occupational therapy, decrease the duration of delirium and should be encouraged. Pharmacological treatment for delirium traditionally includes haloperidol; however, more data for haloperidol are needed given the paucity of placebo-controlled trials testing its efficacy to treat delirium in the ICU. Second-generation antipsychotics have emerged as an alternative for the treatment of delirium, and they may have a better safety profile. Dexmedetomidine may prove to be a valuable adjunctive agent for patients with delirium in the ICU.

No MeSH data available.


Related in: MedlinePlus