Delirium primary prevention: Difference between revisions
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==Overview== | ==Overview== |
Revision as of 06:10, 18 February 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]
Overview
Primary Prevention
Non pharmacological interventions
Pharmacological interventions
It is important to prevent delirium as delirium is itself neurotoxic. It is associated with global brain atrophy and white matter disruption. Various pharmacological interventions have shown promising results in prevention of delirium, which are as follows,
- 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[2]
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, following benefits were observed,
- Prophylactic treatment and early treatment seem to have a better prognosis than treatment of delirium.
- 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 for prophylactic treatment with haloperidol
- Uneccesary treatment to patients who were not destined to develop delirium
- Side effects of treatment, however during clinical studies there was only marginal prolongation of QTc and no one developed ventricular arrhythmias.
Targeted delirium prophylaxis is key to the future management of delirium. More studies are needed on this topic. [3]
Prediction of Delirium in ICU
Early prediction of development of delirium in intensive care is very crucial to start non pharmacological treatment and starting prophylactic haloperidol treatment. PRE-DELIRIC model is used to predict delirium in ICU. Automatic version of the PRE-DELIRIC model (Excel and web based) can be downloaded at http://www.umcn.nl/Research/Departments/intensive%20care/Documents/Pre-deliric%20model.htm?language=english, Complete information is available at http://www.umcn.nl/Research/Departments/intensive%20care/Pages/vandenBoogaard.aspx
References
- ↑ "MMS: Error".
- ↑ "http://ajp.psychiatryonline.org/article.aspx?articleID=1795082". External link in
|title=
(help) - ↑ "Haloperidol prophylaxis in critically ill patients... [Crit Care. 2013] - PubMed - NCBI".
- ↑ "Development and validation of PRE-DELIRIC (PREdiction of... [BMJ. 2012] - PubMed - NCBI".