Delirium primary prevention
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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: Vishal Khurana, M.B.B.S., M.D. [2]; Pratik Bahekar, MBBS [3]
Overview
Primary Prevention
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[1]
Delirium possibly causes exhaustion leading to respiratory difficulties and a higher incidence of re-intubations. 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.
- 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
- Uneccesary treatment to patients who were not destined to develop delirium
- Side effects of treatment, however QTc-time was only marginally prolonged and no one developed ventricular arrhythmias.