Delirium occurs in about half of critically ill patients. Some fairly simple measures may reduce this risk. When it occurs, delirium is a diagnostic challenge because occasionally it can be a sign of a new underlying illness. Treatment is challenging, with little evidence to support most standard therapies.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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thank you guys. excellent.
Great Article as always. What about clonidine? We use a lot of it, maybe too much. Just yesterday evening we had a case of successfully resuscitated asystole – the patient received clonidine continuously and also some neostigmine for his “Number 2”.
Thanks. Have been meaning to do a post on oral alpha-2 agonists (clonidine, guanfacine). Based on popular demand (your comments and some e-mails with Adam Thomas) will move this up and release it in two weeks. Really interesting stuff.
Do you happen to know how quickly the patient received the neostigmine (ie over how much time it was infused)?
I am a CL psychiatrist and treat a lot of agitation 2/2 delirium. We are still concerned with QT prolongation with olanzapine to a similiar degree as Haldol. There is unpublished work by Scott Beach looking into IV haldol which gets a bad rep for QT prolongation but this is largely an artifact of being the most used agent. If you are afraid to use IV haldol because of QT, you should be equally afraid to use Olanzapine. Many pharmacies will restrict us from using IV olanzapine even though it’s totally fine. The only antipsychotic not shown to prolong QT… Read more »
Thanks for another great post. I agree that universal delirium prevention makes a ton of sense. I would like to make an argument for CAM ICU screening though. First, The ICU liberation collaborative timed their nurses and found that administering the CAM averaged 37 seconds which is not a great deal of time. Second delirium is strongly associated with significant cognitive dysfunction which persists as long a a year after ICU discharge. Detecting delirium allows us to counsel our ICU patients and families about the high risk of this life altering outcome. Lastly knowledge of delirium prevalence in our own… Read more »