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Management of Delirium in the ICU - ICUDelirium.org

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Delirious patients may become more obtunded and confused when treated with sedatives, causing a paradoxical increase in agitation as the sedative effects wear ... MedicalProfessionalsICU DeliriumPreventionandSafetyABCDEF OverviewAssess,PreventandManagePainBothSATandSBTChoiceofAnalgesiaandSedationDelirium: Assess,PreventandManageEarlyMobilityandExerciseFamilyEngagementandEmpowermentAdditionalInformationAdultNon-ICU CareandEmergencyDept.Pediatric CareLong-termOutcomesTerminologyandMnemonicsHistorical ReferencesResourcesDownloadsTranslationsVideosDiscoveryTimelineExternalLinksPatientsandFamiliesDeliriumintheIntensiveCareUnitPatientsandFamiliesOverviewWhatToAskYourDoctorCognitiveImpairmentPost-TraumaticStressDisorder(PTSD)DepressionPediatricPatientsPatientTestimonialsTheReturnHomeIthasbeen10months,andIjustkeepwaitingforittostraightenitselfout.ReadMorePatientTestimonialsIcouldnotread,concentrateonTVorevencompletemyapplicationformynextroundoffamilypracticeboards.ReadMorePatientTestimonialsTome,itwasliketheslowrebootingofacomputer.ReadMorePatientTestimonialsIwasdiagnosedwithICUSyndromewhileintheICU,buttheysaiditwouldgoaway!!ReadMorePatientTestimonialsInmymind,Iwasplottingmyescapetohome,thinkingIcouldpickatthethreadsoftheimaginedsewnelasticrestraintsandsetmyselffree.ReadMorePatientTestimonialsAfterIwasextubatedandsedationwasdiscontinued,Icontinuedtohaveparanoiddelusionsaboutthenurseswantingtoharmme.ReadMorePatientTestimonialsIsentyourwebsitetomyfamilyandithaschangedmywife’sopinionaboutme.ThereissomethingaboutknowingthatIamnotaloneanditisn’tmyfaultthatmakesadifference.ReadMorePatientTestimonialsAboutCIBS CenterCIBS CenterInformationCIBS CenterOverviewOurTeamOngoingResearchCOVID-19and CIBS CenterNewsRecent UpdatesAnnual ReportSupporttheResearchContactUsAttheforefrontofdiscoveryandinnovation,improvinglivesofpeopleaffectedbycriticalillness.Weadvanceknowledge,education,andmodelsofcareforpeopleaffectedbycriticalillness.‍ICU RecoveryCenterSupporttheResearchMenuEveryDeep-DrawnBreath-JustPublished!BuyNowforMedical ProfessionalsDelirium: Assess,PreventandManageManagementofDeliriumintheICUDeliriumManagementProtocolProtocolsandevidence-basedstrategiesforpreventionandtreatmentofdeliriumwillnodoubtemergeasmoreevidencebecomesavailablefromongoingrandomizedclinicaltrialsofbothnonpharmacologicalandpharmacologicalstrategies.Ourgrouphasdeliberatelyputoffpublishingadeliriummanagementalgorithmbecauseitwouldnecessitateincorporationof“expertopinion”andthusaspectsthathaveyettobeadequatelytestedorproven.However,therequestsforsuchanapproachcontinuetofloodourexperiencesatnationalandinternationalforumsandnumerousemailswereceivefromwebsitevisitors.Therefore,wehavedevelopedthefollowingSedationandDeliriumManagementProtocol,whichbasicallyandsuccinctlysummarizesourapproachatthecurrenttime.Wewanttoemphasizethatthisapproach,whichislargelybasedonthecurrentSCCMClinicalPracticeGuidelines,(VUMCSedationProtocol)isonewhichneedstobeupdatedregularlywithnewdataandalsopersonalizedateachmedicalcenteraccordingtothoughtleadersatthatcenter.Thisisnota“one-shoe-fits-all”protocol.WehopethatthisdraftprotocolhelpsyouformyourownintegratedapproachtoCNSmonitoring,sedationtargeting,anddeliriummanagementincriticallyillICUpatients.NonpharmacologicPrimarypreventionispreferred;however,somedegreeofdeliriumisinevitableintheICU.Althoughtherearenodataonprimaryprevention(nonpharmacologic)trialsintheICU,thedatainnon-ICUsettingsfocusesonminimizingriskfactors.Thestrategiesincludethefollowinginterventions:RepeatedreorientationofpatientsProvisionsofcognitivelystimulatingactivitiesforthepatientsmultipletimesadayAnonpharmacologicalsleepprotocolEarlymobilizationactivitiesTimelyremovalofcathetersandphysicalrestraintsUseofeyeglassesandmagnifyinglenses,hearingaidsandearwaxdisimpactionEarlycorrectionofdehydrationUseofascheduledpainmanagementprotocolMinimizationofunnecessarynoise/stimuliStrategiesforthepreventionandmanagementofdeliriumintheICUareimportantareasforfutureinvestigation.PharmacologicThefirststepinpharmacologicmanagementofofdeliriumistoassessthepatient’scurrentmedicationsforanyoffendingagentsthatmaybecausingorexacerbatingthedelirium.Inappropriateuseofsedativesoranalgesicsmayexacerbatedeliriumsymptoms.Deliriouspatientsmaybecomemoreobtundedandconfusedwhentreatedwithsedatives,causingaparadoxicalincreaseinagitationasthesedativeeffectswearoff.Infact,benzodiazepinesandnarcoticsthatareoftenusedintheICUtotreat“confusion”(delirium)actuallyworsencognitionandexacerbatetheproblem.Athoroughreviewofapatient’smedicationswillhelpidentifyanysedatives,analgesicsand/oranticholinergicdrugsthatmayberemovedordecreasedindose.ThecurrentPain,Agitation,Delirium,Immobility,andSleepDisruption(PADIS)Guidelines,recommendagainstusinghaloperidoloranatypicalantipsychotictotreatdelirium. Amulticenter,randomized,placebocontrolledtrialin566patientsshowedthathaloperidolandziprasidoneascomparedtoplacebodonotreducedelirium,timeonventilator,ICUorhospitallengthofstay,ordeath. Arrhythmias,Parkinsonism(extrapyramidalsymptoms),NeurolepticMalignantSyndrome,studydrugdiscontinuation,andothersafetyconcernswereextremelylowacrossallthreegroups. Antipsychoticsremainviableforshort-termcontrolofagitation(e.g.,alcoholordrugwithdrawal)orsevereanxietywithneedtoavoidrespiratorysuppression(e.g.,heartfailure,COPD,orasthma).ResourcesDeliriumProtocolDownloadReadMoreRelatedPapersClinicalPracticeGuidelinesforthePreventionandManagementofPain,Agitation/Sedation,Delirium,Immobility,andSleepDisruptioninAdultPatientsintheICU.DevlinJW,SkrobikY,GélinasC,etal.ClinicalPracticeGuidelinesforthePreventionandManagementofPain,Agitation/Sedation,Delirium,Immobility,andSleepDisruptioninAdultPatientsintheICU.CritCareMed.2018;46(9):e825-e873.ViewEffectofDexmedetomidineAddedtoStandardCareonVentilator-FreeTimeinPatientsWithAgitatedDelirium:ARandomizedClinicalTrialReadeMC,etal.,JAMA.2016Apr12;315(14):1460-8ViewHaloperidolandZiprasidoneforTreatmentofDeliriuminCriticalIllnessGirardTD,ExlineMC,CarsonSS,etal.HaloperidolandZiprasidoneforTreatmentofDeliriuminCriticalIllness[publishedonlineaheadofprint,2018Oct22].NEnglJMed.2018;10.1056ViewContinuereadingnext:EarlyMobilityandExerciseContinueReading:EarlyMobilityandExerciseMedicalProfessionalsPatientsandFamiliesCIBS CenterICU RecoveryCenterEveryDeep-DrawnBreathContactUsSupporttheResearchFollowDr. WesElyonTwitter: @WesElyMDCriticalIllness,BrainDysfunction,andSurvivorship(CIBS)Center|Suite450,4thFloor,2525WestEndAvenue|Nashville,TN37203VanderbiltUniversityMedicalCenteriscommittedtoprinciplesofequalopportunityandaffirmativeaction.|Copyright©byVanderbiltUniversityMedicalCenterByclicking“Accept”,youagreetothestoringofcookiesonyourdevicetoenhancesitenavigation,analyzesiteusage,andassistinourmarketingefforts.ViewourPrivacyPolicyformoreinformation.DenyAccept 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