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

Proposed strategy for the initial management of patients with delirium in the ICU.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Proposed strategy for the initial management of patients with delirium in the ICU.

Mentions: Noise in the ICU is known to disturb patients’ sleep [70]. Furthermore, it has been suggested that a disturbed sleep may influence the risk of delirium. The impact of noise on the quality of sleep and thus on the risk of delirium has been illustrated in a recent clinical trial that demonstrated that the use of earplugs at nighttime leads to better sleep and less confusion [71]. Limiting the exposure to sedatives also may have beneficial effects on the risk of delirium. A randomized, clinical trial showed that protocolized daily interruption of sedatives associated with spontaneous breathing trials leads to significantly shorter duration of coma in mechanically ventilated patients but no significant change in delirium in the assessable patients [72]. The addition of physical and occupational therapy to daily interruption of sedation leads to shorter duration of delirium and better functional status in mechanically ventilated patients [73]. Figure 2 presents a proposed strategy for the initial management of patients with delirium in the ICU.


Delirium in the ICU: an overview.

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

Proposed strategy for the initial management of patients with delirium in the ICU.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Proposed strategy for the initial management of patients with delirium in the ICU.
Mentions: Noise in the ICU is known to disturb patients’ sleep [70]. Furthermore, it has been suggested that a disturbed sleep may influence the risk of delirium. The impact of noise on the quality of sleep and thus on the risk of delirium has been illustrated in a recent clinical trial that demonstrated that the use of earplugs at nighttime leads to better sleep and less confusion [71]. Limiting the exposure to sedatives also may have beneficial effects on the risk of delirium. A randomized, clinical trial showed that protocolized daily interruption of sedatives associated with spontaneous breathing trials leads to significantly shorter duration of coma in mechanically ventilated patients but no significant change in delirium in the assessable patients [72]. The addition of physical and occupational therapy to daily interruption of sedation leads to shorter duration of delirium and better functional status in mechanically ventilated patients [73]. Figure 2 presents a proposed strategy for the initial management of patients with delirium in the ICU.

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