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]
- employ non-pharmcologic measures
- multicomponent non-pharmacologic measures diminish the incidence of delirium in hospitalized elderly[11]
- Hospital Elder Life Program (HELP) diminishes incidence of delirium & in-hospital falls in hospitalized elderly[11]
- minimize polypharmacy[10]
- multicomponent non-pharmacologic measures diminish the incidence of delirium in hospitalized elderly[11]
- 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
- ↑ Jump up to: 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
- ↑ Jump up to: 3.0 3.1 Hatta K, Kishi Y, Wada K et al 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
- ↑ Jump up to: 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
- ↑ Jump up to: 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
- ↑ Jump up to: 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
- ↑ Jump up to: 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
- ↑ Jump up to: 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 - ↑ Jump up to: 10.0 10.1 Herling SF, Greve IE, Vasilevskis EE et al Interventions for preventing intensive care unit delirium in adults. Cochrane Database Syst Rev. 2018 Nov 23;11(11):CD009783. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30484283 PMCID: PMC6373634 Free PMC article. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009783.pub2/full
- ↑ Jump up to: 11.0 11.1 11.2 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022-