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Delirium in Critically Ill Patients

Epidemiology, Pathophysiology, Diagnosis and Management

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Abstract

Delirium is commonly observed in critically ill patients and is associated with negative outcomes. The pathophysiology of delirium is not completely understood. However, alterations to neurotransmitters, especially acetylcholine and dopamine, inflammatory pathways and an aberrant stress response are proposed mechanisms leading to intensive care unit (ICU) delirium. Detection of delirium using a validated delirium assessment tool makes early treatment possible, which may improve prognosis. Patients at high risk of delirium, especially those with cognitive decline and advanced age, should be identified in the first 24 hours of admission to the ICU. Whether these high-risk patients benefit from haloperidol prophylaxis deserves further study. The effectiveness of a multicomponent, non-pharmacological approach is shown in non-ICU patients, which provides proof of concept for use in the ICU. The few studies on this approach in ICU patients suggest that the burden of ICU delirium may be reduced by early mobility, increased daylight exposure and the use of earplugs. In addition, the combined use of sedation, ventilation, delirium and physical therapy protocols can reduce the frequency and severity of adverse outcomes and should become part of routine practice in the ICU, as should avoidance of deliriogenic medication such as anticholinergic drugs and benzodiazepines. Once delirium develops, symptomatic treatment with antipsychotics is recommended, with haloperidol being the drug of first choice. However, there is limited evidence on the safety and effectiveness of antipsychotics in ICU delirium.

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References

  1. Adamis D, Treloar A, Martin FC, et al. A brief review of the history of delirium as a mental disorder. Hist Psychiatry 2007 Dec; 18(72 Pt 4): 459–69

    PubMed  Google Scholar 

  2. Meagher D. Motor subtypes of delirium: past, present and future. Int Rev Psychiatry 2009 Feb; 21(1): 59–73

    PubMed  Google Scholar 

  3. Morandi A, Jackson JC, Ely EW. Delirium in the intensive care unit. Int Rev Psychiatry 2009 Feb; 21(1): 43–58

    PubMed  Google Scholar 

  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Revision. Washington, DC: American Psychiatric Association, 2000: 135–47

    Google Scholar 

  5. American Psychiatric Association. Practice guideline for the treatment of patients with delirium. Am J Psychiatry 1999 May; 156(5 Suppl.): 1–20

    Google Scholar 

  6. Ouimet S, Riker R, Bergeon N, et al. Subsyndromal delirium in the ICU: evidence for a disease spectrum [published erratum appears in Intensive Care Med 2007 Sep; 33 (8): 1677]. Intensive Care Med 2007 Jun; 33(6): 1007–13

    PubMed  Google Scholar 

  7. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ 2004 Jun 19; 328(7454): 1490

    PubMed  Google Scholar 

  8. van Eijk MM, Slooter AJ. Delirium in intensive care unit patients. Semin Cardiothorac Vasc Anesth 2010 Jun; 14(2): 141–7

    PubMed  Google Scholar 

  9. Bergeron N, Dubois MJ, Dumont M, et al. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med 2001 May; 27(5): 859–64

    PubMed  CAS  Google Scholar 

  10. Ely EW, Girard TD, Shintani AK, et al. Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients. Crit Care Med 2007 Jan; 35(1): 112–7

    PubMed  CAS  Google Scholar 

  11. Pandharipande P, Shintani A, Peterson J, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 2006 Jan; 104(1): 21–6

    PubMed  CAS  Google Scholar 

  12. Roberts B, Rickard CM, Rajbhandari D, et al. Multicentre study of delirium in ICU patients using a simple screening tool. Aust Crit Care 2005 Feb; 18(1): 6, 4–8

    Google Scholar 

  13. Balas MC, Happ MB, Yang W, et al. Outcomes associated with delirium in older patients in surgical ICUs. Chest 2009 Jan; 135(1): 18–25

    PubMed  Google Scholar 

  14. Angus DC, Kelley MA, Schmitz RJ, et al. Caring for the critically ill patient: current and projected workforce requirements for care of the critically ill and patients with pulmonary disease. Can we meet the requirements of an aging population?. JAMA 2000; 284(21): 2762–70

    PubMed  CAS  Google Scholar 

  15. Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001 Dec; 27(12): 1892–900

    PubMed  CAS  Google Scholar 

  16. Pisani MA, Murphy TE, Araujo KL, et al. Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population. Crit Care Med 2009 Jan; 37(1): 177–83

    PubMed  CAS  Google Scholar 

  17. van Eijk MM, van Marum RJ, Klijn IA, et al. Comparison of delirium assessment tools in a mixed intensive care unit. Crit Care Med 2009 Jun; 37(6): 1881–5

    PubMed  Google Scholar 

  18. Heymann A, Radtke F, Schiemann A, et al. Delayed treatment of delirium increases mortality rate in intensive care unit patients. J Int Med Res 2010 Sep; 38(5): 1584–95

    PubMed  CAS  Google Scholar 

  19. Young J, Murthy L, Westby M, et al. Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ 2010; 341: c3704

    PubMed  Google Scholar 

  20. Martin J, Heymann A, Basell K, et al. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care-short version. Ger Med Sci 2010; 8: Doc02

    PubMed  Google Scholar 

  21. Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002 Jan; 30(1): 119–41

    PubMed  Google Scholar 

  22. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001; 286(21): 2703–10

    PubMed  CAS  Google Scholar 

  23. Luetz A, Heymann A, Radtke FM, et al. Different assessment tools for intensive care unit delirium: which score to use?. Crit Care Med 2010 Feb; 38(2): 409–18

    PubMed  Google Scholar 

  24. Neto AS, Nassar Jr AP, Cardoso SO, et al. Delirium screening in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2012 Jun; 40(6): 1946–51

    PubMed  Google Scholar 

  25. van Eijk MM, van den Boogaard M, van Marum RJ, et al. Routine use of the confusion assessment method for the intensive care unit: a multicenter study. Am J Respir Crit Care Med 2011 Aug 1; 184(3): 340–4

    PubMed  Google Scholar 

  26. Peterson JF, Pun BT, Dittus RS, et al. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc 2006 Mar; 54(3): 479–84

    PubMed  Google Scholar 

  27. Pandharipande P, Cotton BA, Shintani A, et al. Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med 2007 Oct; 33(910): 1726–31

    PubMed  Google Scholar 

  28. Steiner LA. Postoperative delirium. Part 1: pathophysiology and risk factors. Eur J Anaesthesiol 2011 Sep; 28(9): 628–36

    PubMed  CAS  Google Scholar 

  29. Hshieh TT, Fong TG, Marcantonio ER, et al. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci 2008 Jul; 63(7): 764–72

    PubMed  Google Scholar 

  30. Han L, McCusker J, Cole M, et al. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med 2001 Apr 23; 161(8): 1099–105

    PubMed  CAS  Google Scholar 

  31. van Gool WA, van de Beek D, Eikelenboom P. Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet 2010 Feb 27; 375(9716): 773–5

    PubMed  Google Scholar 

  32. Trzepacz PT. Update on the neuropathogenesis of delirium. Dement Geriatr Cogn Disord 1999 Sep; 10(5): 330–4

    PubMed  CAS  Google Scholar 

  33. Trzepacz PT. Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 2000 Apr; 5(2): 132–48

    PubMed  CAS  Google Scholar 

  34. Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 2009 Feb 4; 301(5): 489–99

    PubMed  CAS  Google Scholar 

  35. Janz DR, Abel TW, Jackson JC, et al. Brain autopsy findings in intensive care unit patients previously suffering from delirium: a pilot study. J Crit Care 2010 Sep; 25(3): 538–12

    PubMed  Google Scholar 

  36. Iacobone E, Bailly-Salin J, Polito A, et al. Sepsis-associated encephalopathy and its differential diagnosis. Crit Care Med 2009 Oct; 37(10 Suppl.): S331–6

    PubMed  Google Scholar 

  37. Kruis RW, Vlasveld FA, Van DD. The (un)importance of cerebral microemboli. Semin Cardiothorac Vasc Anesth 2010 Jun; 14(2): 111–8

    PubMed  Google Scholar 

  38. Morandi A, Jackson JC. Delirium in the intensive care unit: a review. Neurol Clin 2011 Nov; 29(4): 749–63

    PubMed  Google Scholar 

  39. van den Boogaard M, Kox M, Quinn KL, et al. Biomarkers associated with delirium in critically ill patients and their relation with long-term subjective cognitive dysfunction; indications for different pathways governing delirium in inflamed and non-inflamed patients. Crit Care 2011 Dec 29; 15(6): R297

    PubMed  Google Scholar 

  40. McGrane S, Girard TD, Thompson JL, et al. Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients. Crit Care 2011; 15(2): R78

    PubMed  Google Scholar 

  41. de Rooij SE, van Munster Korevaar JC, et al. Cytokines and acute phase response in delirium. J Psychosom Res 2007 May; 62(5): 521–5

    PubMed  Google Scholar 

  42. Maclullich AM, Ferguson KJ, Miller T, et al. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res 2008 Sep; 65(3): 229–38

    PubMed  Google Scholar 

  43. Lupien SJ, Maheu F, Tu M, et al. The effects of stress and stress hormones on human cognition: implications for the field of brain and cognition. Brain Cogn 2007 Dec; 65(3): 209–37

    PubMed  CAS  Google Scholar 

  44. Mu DL, Wang DX, Li LH, et al. High serum cortisol level is associated with increased risk of delirium after coronary artery bypass graft surgery: a prospective cohort study. Crit Care 2010; 14(6): R238

    PubMed  Google Scholar 

  45. Trzepacz PT. The neuropathogenesis of delirium: a need to focus our research. Psychosomatics 1994 Jul; 35(4): 374–91

    PubMed  CAS  Google Scholar 

  46. DeBellis R, Smith BS, Choi S, et al. Management of delirium tremens. J Intensive Care Med 2005 May; 20(3): 164–73

    PubMed  Google Scholar 

  47. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA 1996 Mar 20; 275(11): 852–7

    PubMed  CAS  Google Scholar 

  48. McNicoll L, Pisani MA, Zhang Y, et al. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 2003 May; 51(5): 591–8

    PubMed  Google Scholar 

  49. Pisani MA, Murphy TE, Van Ness PH, et al. Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med 2007 Aug 13; 167(15): 1629–34

    PubMed  Google Scholar 

  50. Boogaard M, Pickkers P, Slooter AJ, et al. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ 2012; 344: e420

    PubMed  Google Scholar 

  51. Aldemir M, Ozen S, Kara IH, et al. Predisposing factors for delirium in the surgical intensive care unit. Crit Care 2001 Oct; 5(5): 265–70

    PubMed  CAS  Google Scholar 

  52. Van Rompaey B, Elseviers MM, Schuurmans MJ, et al. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care 2009; 13(3): R77

    PubMed  Google Scholar 

  53. Ouimet S, Kavanagh BP, Gottfried SB, et al. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 2007 Jan; 33(1): 66–73

    PubMed  Google Scholar 

  54. Lin SM, Liu CY, Wang CH, et al. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 2004 Nov; 32(11): 2254–9

    PubMed  CAS  Google Scholar 

  55. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291(14): 1753–62

    PubMed  CAS  Google Scholar 

  56. Kishi Y, Iwasaki Y, Takezawa K, et al. Delirium in critical care unit patients admitted through an emergency room. Gen Hosp Psychiatry 1995 Sep; 17(5): 371–9

    PubMed  CAS  Google Scholar 

  57. Milbrandt EB, Deppen S, Harrison PL, et al. Costs associated with delirium in mechanically ventilated patients. Crit Care Med 2004 Apr; 32(4): 955–62

    PubMed  Google Scholar 

  58. Pisani MA, Kong SY, Kasl SV, et al. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 2009 Dec 1; 180(11): 1092–7

    PubMed  Google Scholar 

  59. van den Boogaard M, Schoonhoven L, Evers AW, et al. Delirium in critically ill patients: impact on long-term health-related quality of life and cognitive functioning. Crit Care Med 2012 Jan; 40(1): 112–8

    PubMed  Google Scholar 

  60. Balas MC, Deutschman CS, Sullivan-Marx EM, et al. Delirium in older patients in surgical intensive care units. J Nurs Scholarsh 2007; 39(2): 147–54

    PubMed  Google Scholar 

  61. Dubois MJ, Bergeron N, Dumont M, et al. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 2001 Aug; 27(8): 1297–304

    PubMed  CAS  Google Scholar 

  62. Cole M, McCusker J, Dendukuri N, et al. The prognostic significance of subsyndromal delirium in elderly medical inpatients. J Am Geriatr Soc 2003 Jun; 51(6): 754–60

    PubMed  Google Scholar 

  63. van Eijk MM, Slooter AJ. Duration of ICU delirium, severity of the underlying disease, and mortality. Am J Respir Crit Care Med 2010 Feb 15; 181(4): 419–20

    PubMed  Google Scholar 

  64. van den Boogaard M, Pickkers P, van der Hoeven H, et al. Implementation of a delirium assessment tool in the ICU can influence haloperidol use. Crit Care 2009; 13(4): R131

    PubMed  Google Scholar 

  65. Riekerk B, Pen EJ, Hofhuis JG, et al. Limitations and practicalities of CAM-ICU implementation, a delirium scoring system, in a Dutch intensive care unit. Intensive Crit Care Nurs 2009 Oct; 25(5): 242–9

    PubMed  Google Scholar 

  66. Weinert CR, Mann HJ. The science of implementation: changing the practice of critical care. Curr Opin Crit Care 2008 Aug; 14(4): 460–5

    PubMed  Google Scholar 

  67. Tabet N, Howard R. Non-pharmacological interventions in the prevention of delirium. Age Ageing 2009 Jul; 38(4): 374–9

    PubMed  Google Scholar 

  68. Marcantonio ER, Flacker JM, Wright RJ, et al. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 2001 May; 49(5): 516–22

    PubMed  CAS  Google Scholar 

  69. Inouye SK, Bogardus Jr ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340(9): 669–76

    PubMed  CAS  Google Scholar 

  70. Immers HE, Schuurmans MJ, van de Bijl JJ. Recognition of delirium in ICU patients: a diagnostic study of the NEECHAM confusion scale in ICU patients. BMC Nurs 2005 Dec 13; 4: 7

    PubMed  Google Scholar 

  71. Van Rompaey B, Elseviers MM, Van Drom W, et al. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Critical Care 2012 May 4; 16: R73

    PubMed  Google Scholar 

  72. Zaal IJ, Peelen LM, Spruyt CF, et al. Nursing environment and delirium in ICU patients [abstract no. P334]. Critical Care 2011 Mar 11; 15 Suppl. 1: P334. Plus poster presented at the 31st International Symposium on Intensive Care and Emergency Medicine; 2011 Mar 22–25; Brussels

    Google Scholar 

  73. Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009 May 30; 373(9678): 1874–82

    PubMed  Google Scholar 

  74. Needham DM, Korupolu R, Zanni JM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil 2010 Apr; 91(4): 536–42

    PubMed  Google Scholar 

  75. Gamberini M, Bolliger D, Lurati Buse GA, et al. Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery: a randomized controlled trial. Crit Care Med 2009 May; 37(5): 1762–8

    PubMed  CAS  Google Scholar 

  76. Hudetz JA, Patterson KM, Iqbal Z, et al. Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2009 Oct; 23(5): 651–7

    PubMed  CAS  Google Scholar 

  77. Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 2007 Dec 12; 298(22): 2644–53

    PubMed  CAS  Google Scholar 

  78. Prakanrattana U, Prapaitrakool S. Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care 2007 Oct; 35(5): 714–9

    PubMed  CAS  Google Scholar 

  79. Wang W, Li HL, Wang DX, et al. Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial. Crit Care Med 2012 Mar; 40(3): 731–9

    PubMed  CAS  Google Scholar 

  80. Devlin JW, Roberts RJ, Fong JJ, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med 2010 Feb; 38(2): 419–27

    PubMed  CAS  Google Scholar 

  81. Girard TD, Pandharipande PP, Carson SS, et al. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med 2010 Feb; 38(2): 428–37

    PubMed  CAS  Google Scholar 

  82. Skrobik YK, Bergeron N, Dumont M, et al. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med 2004 Mar; 30(3): 444–9

    PubMed  Google Scholar 

  83. van Eijk MM, Roes KC, Honing ML, et al. Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial. Lancet 2010 Nov 27; 376(9755): 1829–37

    PubMed  Google Scholar 

  84. Campbell N, Boustani MA, Ayub A, et al. Pharmacological management of delirium in hospitalized adults: a systematic evidence review. J Gen Intern Med 2009 Jul; 24(7): 848–53

    PubMed  Google Scholar 

  85. Bourne RS, Tahir Borthwick M, et al. Drug treatment of delirium: past, present and future. J Psychosom Res 2008 Sep; 65(3): 273–82

    PubMed  Google Scholar 

  86. Tabet N, Howard R. Pharmacological treatment for the prevention of delirium: review of current evidence. Int J Geriatr Psychiatry 2009 Oct; 24(10): 1037–44

    PubMed  Google Scholar 

  87. Bourne RS, Mills GH. Melatonin: possible implications for the postoperative and critically ill patient. Intensive Care Med 2006 Mar; 32(3): 371–9

    PubMed  CAS  Google Scholar 

  88. Hanania M, Kitain E. Melatonin for treatment and prevention of postoperative delirium. Anesth Analg 2002 Feb; 94(2): 338–9

    PubMed  Google Scholar 

  89. Gaudreau JD, Gagnon P, Roy MA, et al. Association between psychoactive medications and delirium in hospitalized patients: a critical review. Psychosomatics 2005 Jul; 46(4): 302–16

    PubMed  Google Scholar 

  90. Clegg A, Young JB. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing 2011 Jan; 40(1): 23–9

    PubMed  Google Scholar 

  91. Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry 2001; 62 Suppl. 21: 11–4

    PubMed  CAS  Google Scholar 

  92. Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule for delirium after elective non-cardiac surgery. JAMA 1994 Jan 12; 271(2): 134–9

    PubMed  CAS  Google Scholar 

  93. Pandharipande P, Cotton BA, Shintani A, et al. Prevalence and Risk Factors for Development of Delirium in Surgical and Trauma Intensive Care Unit Patients. J Trauma 2008 Jul; 65(1): 34–41

    PubMed  Google Scholar 

  94. Morrison RS, Magaziner J, Gilbert M, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci 2003 Jan; 58(1): 76–81

    PubMed  Google Scholar 

  95. Shehabi Y, Grant P, Wolfenden H, et al. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology 2009 Nov; 111(5): 1075–84

    PubMed  CAS  Google Scholar 

  96. Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA 2012 Mar 21; 307(11): 1151–60

    PubMed  CAS  Google Scholar 

  97. Kress JP, Pohlman AS, O’Connor MF, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342(20): 1471–7

    PubMed  CAS  Google Scholar 

  98. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996 Dec 19; 335(25): 1864–9

    PubMed  CAS  Google Scholar 

  99. Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 2008 Jan 12; 371(9607): 126–34

    PubMed  Google Scholar 

  100. Morandi A, Brummel NE, Ely EW. Sedation, delirium and mechanical ventilation: the ‘ABCDE’ approach. Curr Opin Crit Care 2011 Feb; 17(1): 43–9

    PubMed  Google Scholar 

  101. Skrobik Y, Ahern S, Leblanc M, et al. Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates. Anesth Analg 2010 Aug; 111(2): 451–63

    PubMed  Google Scholar 

  102. Seitz DP, Gill SS, van Zyl LT. Antipsychotics in the treatment of delirium: a systematic review. J Clin Psychiatry 2007 Jan; 68(1): 11–21

    PubMed  CAS  Google Scholar 

  103. Flaherty JH, Gonzales JP, Dong B. Antipsychotics in the treatment of delirium in older hospitalized adults: a systematic review. J Am Geriatr Soc 2011 Nov; 59 Suppl. 2: S269–76

    PubMed  Google Scholar 

  104. Lundstrom M, Edlund A, Karlsson S, et al. A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc 2005 Apr; 53(4): 622–8

    PubMed  Google Scholar 

  105. Reade MC, O’Sullivan K, Bates S, et al. Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Crit Care 2009; 13(3): R75

    PubMed  Google Scholar 

  106. Kapur S, Seeman P. Does fast dissociation from the dopamine d(2) receptor explain the action of atypical antipsychotics? A new hypothesis. Am J Psychiatry 2001 Mar; 158(3): 360–9

    PubMed  CAS  Google Scholar 

  107. Devlin JW, Bhat S, Roberts RJ, et al. Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight states. Ann Pharmacother 2011 Oct; 45(10): 1217–29

    PubMed  Google Scholar 

  108. Swan JT, Fitousis K, Hall JB, et al. Antipsychotic use and diagnosis of delirium in the intensive care unit. Crit Care 2012 May 16; 16(3): R84

    PubMed  Google Scholar 

  109. Riker RR, Fraser GL, Richen P. Movement disorders associated with withdrawal from high-dose intravenous haloperidol therapy in delirious ICU patients. Chest 1997 Jun; 111(6): 1778–81

    PubMed  CAS  Google Scholar 

  110. Fischer P. Successful treatment of nonanticholinergic delirium with a cholinesterase inhibitor. J Clin Psychopharmacol 2001 Feb; 21(1): 118

    PubMed  CAS  Google Scholar 

  111. Oldenbeuving AW, de Kort PL, Jansen BP, et al. A pilot study of rivastigmine in the treatment of delirium after stroke: a safe alternative. BMC Neurol 2008; 8: 34

    PubMed  Google Scholar 

  112. Overshott R, Vernon M, Morris J, et al. Rivastigmine in the treatment of delirium in older people: a pilot study. Int Psychogeriatr 2010 Aug; 22(5): 812–8

    PubMed  Google Scholar 

  113. Marcantonio ER, Palihnich K, Appleton P, et al. Pilot randomized trial of donepezil hydrochloride for delirium after hip fracture. J Am Geriatr Soc 2011 Nov; 59 Suppl. 2: S282–8

    PubMed  Google Scholar 

  114. Gagnon B, Low G, Schreier G. Methylphenidate hydrochloride improves cognitive function in patients with advanced cancer and hypoactive delirium: a prospective clinical study. J Psychiatry Neurosci 2005 Mar; 30(2): 100–7

    PubMed  Google Scholar 

  115. Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007 May; 6(5): 442–55

    PubMed  CAS  Google Scholar 

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Acknowledgements

The authors thank A.W. van der Kooij, MSc and M.M.E. van Eijk, M.D., PhD., Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands, for commenting on a previous version of this manuscript.

No sources of funding were used to conduct this study or prepare this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this article.

Both IJZ and AJCS reviewed literature concerning (ICU) delirium and drafted the manuscript. Both authors approved the final manuscript. The corresponding author (IJZ) had final responsibility for the decision to submit for publication.

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Correspondence to Irene J. Zaal MD.

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Zaal, I.J., Slooter, A.J.C. Delirium in Critically Ill Patients. Drugs 72, 1457–1471 (2012). https://doi.org/10.2165/11635520-000000000-00000

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