Delirium primary prevention: Difference between revisions
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:* Early recognition and prompt treatment.<ref>{{Cite web | last = | first = | title = MMS: Error | url = http://www.nejm.org/doi/full/10.1056/NEJM199903043400901 | publisher = | date = | accessdate = }}</ref> | :* Early recognition and prompt treatment.<ref>{{Cite web | last = | first = | title = MMS: Error | url = http://www.nejm.org/doi/full/10.1056/NEJM199903043400901 | publisher = | date = | accessdate = }}</ref> | ||
===Pharmacological Interventions=== | ===Pharmacological Interventions=== | ||
* Post operative delirium | * Post operative [[delirium] | ||
:* [[Haloperidol]] | :* [[Haloperidol]] | ||
:* Second-generation [[antipsychotics]] | :* Second-generation [[antipsychotics]] | ||
:* Iliac fascia block | :* [[Iliac]] fascia block | ||
:* [[Gabapentin]] | :* [[Gabapentin]] | ||
:* Lower levels of intraoperative [[propofol]] sedation | :* Lower levels of intraoperative [[propofol]] sedation | ||
:* A single dose of [[ketamine]] during anesthetic induction | :* A single dose of [[ketamine]] during [[anesthetic]] induction | ||
*Mechanically ventilated medical and surgical ICU patients | :*Mechanically [[ventilated]] [[medical]] and [[surgical]] [[ICU]] [[patients]] | ||
:* Continuous intravenous infusion of [[dexmedetomidine]] | :* Continuous [[intravenous ]] infusion of [[dexmedetomidine]] | ||
* Acutely ill general medical patients population | :* Acutely ill general medical patients population | ||
:* Melatonin | :* [[Melatonin] | ||
====[[Haloperidol]]==== | |||
====Haloperidol==== | [[Delirium]] possibly causes exhaustion leading to respiratory difficulties and a higher incidence of re-[[intubations]]. | ||
Delirium possibly causes exhaustion leading to respiratory difficulties and a higher incidence of re-intubations. | Low dose [[haloperidol]], if given prophylactically in lower doses, have a better prognosis than treatment of [[delirium]]. | ||
Low dose [[haloperidol]], if given prophylactically in lower doses, have a better prognosis than treatment of delirium. | * The following benefits were observed: | ||
* Lower mortality | * Lower [[mortality]] | ||
* Lower delirium incidence | * Lower [[delirium]] incidence | ||
* More delirium free days | * More [[delirium]] free days | ||
* Patients are less likely to remove their tubes or catheters | * [[Patients]] are less likely to remove their [[tubes]] or [[catheters]] | ||
* Patients with a higher risk of developing delirium benefited more | * [[Patients]] with a higher risk of developing [[delirium]] benefited more | ||
* ICU readmission rate was lower. | * [[ICU]] readmission rate was lower. | ||
Drawbacks of prophylactic treatment with [[Haloperidol]]: | :*Drawbacks of [[prophylactic]] treatment with [[Haloperidol]]: | ||
* Unnecessary treatment to patients who were not destined to develop delirium | * Unnecessary treatment to [[patients]] who were not destined to develop [[delirium]] | ||
* Side effects of treatment, however during clinical studies there was only a marginal prolongation of [[QTc]] and no one developed [[ventricular arrhythmias]]. | * Side effects of treatment, however during clinical studies there was only a marginal prolongation of [[QTc]] and no one developed [[ventricular arrhythmias]]. | ||
Targeted delirium prophylaxis is key to the future management of delirium and more studies are needed on this topic. | Targeted [[delirium]] prophylaxis is key to the future management of [[delirium]] and more studies are needed on this topic. | ||
<ref>{{Cite web | last = | first = | title = Haloperidol prophylaxis in critically ill patients... [Crit Care. 2013] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/23327295 | publisher = | date = | accessdate = }}</ref> | <ref>{{Cite web | last = | first = | title = Haloperidol prophylaxis in critically ill patients... [Crit Care. 2013] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/23327295 | publisher = | date = | accessdate = }}</ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 05:23, 15 April 2021
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Delirium On the Web |
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American Roentgen Ray Society Images of Delirium |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]
Overview
It is important to prevent delirium as delirium is itself neurotoxic. It is associated with global brain atrophy and white matter disruption. Various non pharmacological and pharmacological interventions are found to be effective to prevent delirium.
Primary Prevention
Non Pharmacological Interventions
Targeted symptomatic intervention can help prevent the emergence of delirium, however, non pharmacological approaches can curtail the incidence of delirium and not effective in preventing recurrence of delirium once delirium has set it. This is why primary prevention is more important. Following are a few preventive strategies for delirium;
Curtail cognitive decline
- Write names of care providers, the day’s schedule on board
- Constantly reorient patients to surroundings
- Activities to stimulate cognitive actions like discussion of current events, structured reminiscence, or word games
Curtail sleep impairment
- Reduce environmental noise
- Relaxing activities such as music, back massage
Curtail immobility
- Minimal use of catheter or other aids which promotes immobility
- Early mobilization
- Incorporation of an exercise regiment
Manage difficulties in sight
- Use of visual aids
- Use of large fluorescent tapes or objects with illuminations to help in vision
Manage difficulties in hearing
- Use of aids
- Ear care
Avoid dehydration
- Regular hydration
- Early recognition and prompt treatment.[1]
Pharmacological Interventions
- Post operative [[delirium]
- Haloperidol
- Second-generation antipsychotics
- Iliac fascia block
- Gabapentin
- Lower levels of intraoperative propofol sedation
- A single dose of ketamine during anesthetic induction
- Mechanically ventilated medical and surgical ICU patients
- Continuous intravenous infusion of dexmedetomidine
- Acutely ill general medical patients population
- [[Melatonin]
Haloperidol
Delirium possibly causes exhaustion leading to respiratory difficulties and a higher incidence of re-intubations. Low dose haloperidol, if given prophylactically in lower doses, have a better prognosis than treatment of delirium.
- The following benefits were observed:
- Lower mortality
- Lower delirium incidence
- More delirium free days
- Patients are less likely to remove their tubes or catheters
- Patients with a higher risk of developing delirium benefited more
- ICU readmission rate was lower.
- Drawbacks of prophylactic treatment with Haloperidol:
- Unnecessary treatment to patients who were not destined to develop delirium
- Side effects of treatment, however during clinical studies there was only a marginal prolongation of QTc and no one developed ventricular arrhythmias.
Targeted delirium prophylaxis is key to the future management of delirium and more studies are needed on this topic. [2]