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Sedative and Analgesic Medications: Risk Factors for Delirium and Sleep Disturbances in the Critically Ill

Division of Critical Care, Department of Anesthesiology, Vanderbilt University School of Medicine, 324 MAB, 1313 21st Avenue South, Nashville, TN 37232, USA.
Critical Care Clinics (Impact Factor: 2.16). 05/2006; 22(2):313-27, vii. DOI: 10.1016/j.ccc.2006.02.010
Source: PubMed

ABSTRACT

Sedatives and analgesics are routinely used in critically ill patients, although they have the potential for side effects, such as delirium and sleep architecture disruption. Although it should be emphasized that these medications are extremely important in providing patient comfort, health care professionals must also strive to achieve the right balance of sedative and analgesic administration through greater focus on reducing unnecessary or overzealous use. Ongoing clinical trials should help us to understand whether altering the delivery strategy, via daily sedation interruption, or protocolized target-based sedation or changing sedation paradigms to target different central nervous system receptors can affect cognitive outcomes and sleep preservation in our critically ill patients.

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    • "Delirium is characterized as a transient state of confusion and disorientation with fluctuating intensity, often accompanied by cognitive impairment. Delirium is a strong predictor of longer ICU length of stay, mechanical ventilation use, and even mortality.85 Sleep deprivation can result in delirium-like symptoms, such as inattention and fluctuations in mental capacity; however, it is still unclear whether sleep disruption in the ICU is a cause, consequence, or comorbidity of delirium. "
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    • "The dopaminergic, cholinergic , GABAergic, serotonergic, and glutamatergic modulatory systems have all been proposed as possible pathways, but the exact pathophysiology remains uncertain [1-3]. Most drugs known to induce or exacerbate delirium are thought to do so through one of these pathways [2]. "

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    • "Establishing causality has been difficult because these drugs are often given to treat pre-existing behaviors that may result from delirium. In an attempt to establish causality to these drugs, Pandharipande et al. (2006) evaluated 11 covariates to determine factors that may contribute to the development of delirium. Lorazepam was an independent risk factor for developing delirium and patients receiving more than 20 mg of lorazepam over 24 h nearly developed subsequently delirium. "
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