prevention of delirium
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Management
- identification of risk factors
- risk prediction tool (the PRE-DELIRIC) used in the 1st 24 hours of the ICU stay may be of benefit[2]
- risk factors include
- age is the greatest risk factor in this model[2]
- case type: neurologic > trauma > medical > surgical
- severity of illness (APACHE-II score)
- Glasgow coma scale
- use of narcotics or sedatives
- metabolic acidosis
- renal failure
- risk factors include
- risk prediction tool (the PRE-DELIRIC) used in the 1st 24 hours of the ICU stay may be of benefit[2]
- minimize polypharmacy
- treat medical disorders
- avoid dehydration
- postoperative: keep hematocrit >= 30%
- optimize the senses
- provide orientation
- familiarize surroundings
- minimize distractions
- adequate lighting
- consistency of staff
- calendar, clock, name of facility visible
- prevent sleep deprivation
- supportive environment
- reduce clutter & noise
- provide adequate lighthing
- bring objects from home
- emotional support
- caring attitude & patience
- family access
- communicate clearly
- compensate for sensory loss, speak slowly
- avoid jargon
- reinforce with gestures
- patient & family education
- avoid restraints
- vigilance for urinary retention
- avoid unnecessary use of urinary catheter or other unneeded catheters
- encourage mobility ASAP with appropriate assistance & supervision
- evidence does not support use of antipsychotics, cholinesterase inhibitors or melatonin for prevention of delirium[7][8]
More general terms
References
- ↑ Mahler ME, In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ 2.0 2.1 2.2 Van den Boogaard M, Pickkers P, Slooter AJC, et al. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicenter study. BMJ 2012; 344:e420 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22323509
- ↑ 3.0 3.1 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Hatta K, Kishi Y, Wada K et l Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA Psychiatry. 2014 Apr;71(4):397-403 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24554232 - ↑ 4.0 4.1 De Rooij SE, van Munster BC, de Jonghe A. Melatonin prophylaxis in delirium: panacea or paradigm shift? JAMA Psychiatry. 2014;71:364-365. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24554149
- ↑ 5.0 5.1 Al-Aama T, Brymer C, Gutmanis I, et al. Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial. Int J Geriatr Psychiatry. 2011;26:687-694 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20845391
- ↑ Holroyd-Leduc JM, Khandwala F, Sink KM. How can delirium best be prevented and managed in older patients in hospital? CMAJ. 2010;182:265-270. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19687107
- ↑ 7.0 7.1 Neufeld KJ, Yue J, Robinson TN, et al. Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2016;64(4):705 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27004732 Free PMC Article
- ↑ 8.0 8.1 Siddiqi N, Harrison JK, Clegg A, et al. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2016; Issue 3. Art. No.: CD005563 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26967259
- ↑ 9.0 9.1 Wu YC, Tseng PT, Tu YK et al. Association of delirium response and safety of pharmacological interventions for the management and prevention of delirium: A network meta-analysis. JAMA Psychiatry 2019 Feb 27; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30810723 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2726609
Blazer DG. Pharmacologic intervention for the treatment and prevention of delirium: Looking beneath the modeling. JAMA Psychiatry 2019 Feb 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30810716 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2726605