Managing ICU delirium

Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Current opinion in critical care (Impact Factor: 2.62). 02/2011; 17(2):131-40. DOI: 10.1097/MCC.0b013e32834400b5
Source: PubMed


ICU delirium is a common and serious acute brain dysfunction with adverse outcome and high risk of mortality. The awareness of ICU delirium as a problem, which immediately requires therapeutic intervention, has been increased in the past years. This article aims to provide information in order to increasingly modify the management of this severe problem, that is, its detection, prevention, and treatment toward algorithm-based and protocol-driven procedures.
The bundle of target-controlled and protocol-driven management of sedation, analgesia, and delirium and its monitoring included in this work offer the opportunity to improve the outcome of ICU patients based on the best evidence available to date. Moreover, the knowledge about precipitating and predisposing factors to prevent ICU delirium is essential and is represented in this review. Unresolved seems the pharmacological therapy of delirium because of the contradictory results of research published so far, especially regarding neuroleptics and cholinesterase inhibitors.
The management of ICU delirium must be a key aspect to improve the outcome of critically ill patients. The development of pharmacological treatment strategies and deeper understanding of the underlying pathophysiology will require further research.

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    • "Correcting the acidosis alone was not enough to manage the delirium and the treatment was challenging. Delirium in patients treated in intensive care unit has been reported as a common and serious acute brain dysfunction with adverse outcome and high risk of mortality (1). Delirium is characterized by four features: 1) inattention and disturbance of consciousness, 2) change in cognition, 3) acute onset and fluctuating course, and 4) presence of a pathophysiological cause (2). "
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    ABSTRACT: Delirium is a common problem in intensive care patients, frequently underdiagnosed and resulting in prolonged hospital stay and a high risk of morbidity and mortality. On the other hand, reversibility of the condition points to the importance of prevention, early diagnosis and immediate therapy. Management strategy is directed to nonpharmacological interventions as preventive measures and pharmacological treatment, which includes typical and atypical neuroleptics. Delirium management includes haloperidol as the first line medication, but also olanzapine and risperidone as atypical neuroleptics. Benzodiazepines are used in delirium caused by alcohol withdrawal.
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