Delirium primary prevention: Difference between revisions
Jump to navigation
Jump to search
| Line 6: | Line 6: | ||
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. | 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== | ==Primary Prevention== | ||
Effective measures for the primary prevention of [[delirium]] include pharmacologic and nonpharmacologic approaches. | |||
===Non Pharmacological Interventions=== | ===Non Pharmacological Interventions=== | ||
*Nonpharmacological approaches may curtail the incidence of [[delirium]]. | |||
* Following are a few preventive strategies for [[delirium]]: | |||
'''Curtail cognitive decline''' | '''Curtail [[cognitive]] decline''' | ||
:* Write names of care providers, the day’s schedule on board | :* Write names of care providers, the day’s schedule on board | ||
:* Constantly reorient patients to surroundings | :* Constantly reorient [[patients]] to surroundings | ||
:* Activities to stimulate cognitive actions like discussion of current events, structured reminiscence, or word games | :* Activities to stimulate [[cognitive]] actions like discussion of current events, structured [[reminiscence]], or word games | ||
'''Curtail sleep impairment''' | '''Curtail [[sleep]] impairment''' | ||
:* Reduce environmental noise | :* Reduce [[environmental]] noise | ||
:* Relaxing activities such as music, back massage | :* Relaxing activities such as [[ music]], back massage | ||
'''Curtail immobility''' | '''Curtail [[immobility]]''' | ||
:* Minimal use of catheter or other aids which promotes immobility | :* Minimal use of [[catheter]] or other aids which promotes immobility | ||
:* Early mobilization | :* Early mobilization | ||
:* Incorporation of an exercise regiment | :* Incorporation of an [[exercise]] regiment | ||
'''Manage difficulties in sight''' | '''Manage difficulties in sight''' | ||
:* Use of visual aids | :* Use of [[visual]] aids | ||
:* Use of large fluorescent tapes or objects with illuminations to help in vision | :* Use of large fluorescent tapes or objects with illuminations to help in [[vision]] | ||
'''Manage difficulties in hearing''' | '''Manage difficulties in [[hearing]]''' | ||
:* Use of aids | :* Use of [[aids]] | ||
:* Ear care | :* [[Ear]] care | ||
'''Avoid dehydration''' | '''Avoid [[dehydration]]''' | ||
:* Regular hydration | :* Regular [[hydration]] | ||
:* 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=== | ||
Revision as of 05:38, 15 April 2021
|
Delirium Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Delirium On the Web |
|
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
Effective measures for the primary prevention of delirium include pharmacologic and nonpharmacologic approaches.
Non Pharmacological Interventions
- Nonpharmacological approaches may curtail the incidence of delirium.
- 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
Manage difficulties in sight
Manage difficulties in hearing
Avoid dehydration
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.
References
- ↑ "MMS: Error".
- ↑ "Haloperidol prophylaxis in critically ill patients... [Crit Care. 2013] - PubMed - NCBI".
- ↑ Schrijver, Edmée JM; de Vries, Oscar J; Verburg, Astrid; de Graaf, Karola; Bet, Pierre M; van de Ven, Peter M; Kamper, Ad M; Diepeveen, Sabine HA; Anten, Sander; Siegel, Andrea; Kuipéri, Esther; Lagaay, Anne M; van Marum, Rob J; van Strien, Astrid M; Boelaarts, Leo; Pons, Douwe; Kramer, Mark HH; Nanayakkara, Prabath WB (2014). "Efficacy and safety of haloperidol prophylaxis for delirium prevention in older medical and surgical at-risk patients acutely admitted to hospital through the emergency department: study protocol of a multicenter, randomised, double-blind, placebo-controlled clinical trial". BMC Geriatrics. 14 (1). doi:10.1186/1471-2318-14-96. ISSN 1471-2318.