Tag: delirium

Upvote Story 5
Among critically ill patients, haloperidol administration compared with placebo does not significantly affect short-term mortality, incidence of delirium, ICU length of stay, or delirium or coma-free days. Additionally, there was no increased risk of adverse events. Six RCTs representing 2552 patients. There was no significant difference between haloperidol and placebo-treated patients in short-term all-cause mortality, incidence of delirium, ICU length of stay, or delirium/coma-free days.... Read More | Comment
Upvote Story 5
THOSE who anesthetize patients with ketamine (originally given the clinical investigation number CI-581) realize it is a unique pharmacological agent. Ever since its introduction into human clinical anesthesia, ketamine has had a turbulent history. One only has to witness ketamine anesthesia emergence delirium to realize this agent produces unique psychic effects. Nevertheless, the value and safety of ketamine in the anesthetic management of a specific... Read More | Comment
Upvote Story 5
A few years ago, I received report that a patient was ready to be weaned from the ventilator. He had no respiratory need for mechanical ventilation, and every time the medical team attempted to wean sedation to extubate, the patient “went crazy.” As I assumed care on the night shift, I looked into the eyes of this intubated 67-year-old male patient. I asked him gently... Read More | Comment
Upvote Story 6
First-, second-, and third-generation cephalosporins doubled the odds of delirium after baseline co-morbidities, ICU type, the course of critical care, and other competing antimicrobial and psychotropic medication risks were adjusted for. We did not find an association between delirium and cefepime, penicillins, carbapenems, fluoroquinolones, or macrolides. Of 418 ICU patients, delirium occurred in 308 (74%) with a median of 3 days among those affected and 318... Read More | Comment
Upvote Story 6
ABCDEF bundle performance showed significant and clinically meaningful improvements in outcomes including survival, mechanical ventilation use, coma, delirium, restraint-free care, ICU readmissions, and post-ICU discharge disposition. Complete ABCDEF bundle performance was associated with lower likelihood of seven outcomes: hospital death within 7 days, next-day mechanical ventilation, coma, delirium, physical restraint use, ICU readmission, and discharge to a facility other than home. We defined ABCDEF bundle... Read More | Comment
Upvote Story 6
A new study finding that two antipsychotics were no more effective than placebo for delirium in critical illness spurs discussion about alternative methods for managing that care. Neither haloperidol nor ziprasidone — both antipsychotics — significantly alters the duration of delirium in critical illness, according to a new clinical trial published online October 22 in the New England Journal of Medicine. The trial randomized 566... Read More | Comment
Upvote Story 5
Patient mobilization and physical rehabilitation in the ICU appears safe, with a low incidence of potential safety events, and only rare events having any consequences for patient management. Heterogeneity in the definition of safety events across studies emphasizes the importance of implementing existing consensus-based definitions. Heterogeneity was assessed by I2 statistics, and bias assessed by the Newcastle-Ottawa Scale and Cochrane risk of bias assessment. The... Read More | Comment
Upvote Story 6
Survivors of critical illness frequently experience poor physical outcomes, including persistent impairments in muscle strength, exercise capacity and physical function. In this article, we review these impairments and recent clinical trials evaluating physical rehabilitation during critical illness as a potential means to improve these outcomes, and conclude with considerations for future studies in the field. Muscle wasting and weakness commonly develops within days of ICU... Read More | Comment
Upvote Story 12
The predictive models evaluated in this study demonstrated moderate to good discriminative ability to predict ICU patients’ risk of developing delirium. Models calculated at 24-hours post-ICU admission appear to be more accurate but may have limited utility in practice. There were 803 ICU admissions during the study period, of which 455 met inclusion criteria. 35.2% (n = 160) were Confusion Assessment Method for ICU positive... Read More | Comment
Upvote Story 5
Current evidence does not support the use of non-pharmacological interventions in reducing incidence and duration of delirium in critically ill patients. Future research should consider well-designed and well-described multicomponent interventions and include adequately defined outcome measures. We identified 15 trials (2812 participants). Eleven trials reported incidence of delirium. Pooled data from four trials of bright light therapy showed no significant effect between groups (n = 829 participants,... Read More | Comment
Upvote Story 8
Delirium is defined as an acute disorder of consciousness which can occur in up to 80% of mechanically ventilated ICU patients. This acute cognitive dysfunction is associated with prolonged hospital stay, increased mortality, longer periods of mechanical ventilation and long-term cognitive impairment compared to patients without delirium. Haloperidol, remains one of the most commonly used typical antipsychotics used to treat delirium internationally and within the... Read More | Comment
Upvote Story 5
In patients receiving palliative care, individualized management of delirium precipitants and supportive strategies result in lower scores and shorter duration of target distressing delirium symptoms than when risperidone or haloperidol are added. wo hundred forty-seven participants (mean [SD] age, 74.9 [9.8] years; 85 women [34.4%]; 218 with cancer [88.3%]) were included in intention-to-treat analysis (82 receiving risperidone, 81 receiving haloperidol, and 84 receiving placebo). Read More | Comment
Upvote Story 7
The results highlight the heterogeneity in sedation practices among intensivists who care for critically ill children as well as a paucity of sleep promotion and delirium screening in PICUs worldwide. The survey was completed by 341 respondents, the majority of whom were from North America (70%). Twenty-seven percent of respondents reported having written sedation protocols. Most respondents worked in PICUs with sedation scoring systems (70%),... Read More | Comment
Upvote Story 4
The evidence-based ABCDEF bundle was successfully implemented in seven community hospital ICUs using an interprofessional team model to operationalize the Pain, Agitation, and Delirium guidelines. Higher bundle compliance was independently associated with improved survival and more days free of delirium and coma after adjusting for age, severity of illness, and presence of mechanical ventilation. Total and partial bundle compliance were measured daily. Random effects regression... Read More | Comment
Upvote Story 6
Recently the MINDS-USA trial evaluated the use of haloperidol or ziprasidone for delirium in critical illness. Before jumping into the results of this study, it will help to establish a couple of foundational principles. Overall, antipsychotics don’t reverse the underlying pathophysiologic causes of delirium. However, antipsychotics can be useful to alleviate symptoms of agitation and insomnia, allowing the patient to be managed safely while delirium... Read More | Comment