Delirium primary prevention: Difference between revisions
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===Non Pharmacological Interventions=== | ===Non Pharmacological Interventions=== | ||
*Nonpharmacological approaches may curtail the incidence of [[delirium]]. | *Nonpharmacological approaches may curtail the incidence of [[delirium]]. | ||
* Following are a few preventive strategies for [[delirium]]: | * Following are a few preventive strategies for [[delirium]]:<ref name="pmid29997660">{{cite journal |vauthors=Ghaeli P, Shahhatami F, Mojtahed Zade M, Mohammadi M, Arbabi M |title=Preventive Intervention to Prevent Delirium in Patients Hospitalized in Intensive Care Unit |journal=Iran J Psychiatry |volume=13 |issue=2 |pages=142–147 |date=April 2018 |pmid=29997660 |pmc=6037578 |doi= |url=}}</ref> | ||
'''Curtail [[cognitive]] decline''' | '''Curtail [[cognitive]] decline''' | ||
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:* 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 05:53, 15 April 2021
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Delirium Microchapters |
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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
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:[1]
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
- ↑ Ghaeli P, Shahhatami F, Mojtahed Zade M, Mohammadi M, Arbabi M (April 2018). "Preventive Intervention to Prevent Delirium in Patients Hospitalized in Intensive Care Unit". Iran J Psychiatry. 13 (2): 142–147. PMC 6037578. PMID 29997660.
- ↑ "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.