Letter to the editor: Quetiapine safety in ICU delirium management among SARS-CoV-2-infected patients

Background Delirium affects up to 80% of patients in the intensive care unit (ICU) but is missed in up to 75% of cases. Telehealth in the ICU (tele-ICU) has become the standard for providing timely, expert care to remotely located ICUs. Objectives This pilot study assessed the feasibility and acceptability of using tele-ICU to increase the accuracy of delirium screening and recognition by ICU nurses. Methods The pilot sites included 4 ICUs across 3 hospitals. A geriatrician with delirium expertise remotely observed 13 bedside ICU nurses administering the Confusion Assessment Method for the ICU (CAM-ICU) to patients in real time via the tele-ICU platform and subsequently provided training on CAM-ICU performance and delirium management. Training evaluation consisted of a validated spot check form, a 2-item satisfaction/change-of-practice survey, and a qualitative question on acceptability. Results Thirteen ICU nurses were observed performing 26 bedside delirium assessments. The top observed barriers to accurate delirium screening were CAM-ICU knowledge deficits, establishment of baseline cognition, and inappropriate use of the “unable to assess” designation. The mean percentage of correct observations improved from 40% (first observation) to 90% (second observation) (P < .001). All 13 nurses strongly agreed that the training was beneficial and practice changing. Conclusions The use of tele-ICU to improve the accuracy of delirium screening by ICU nurses appears to be feasible and efficient for leveraging delirium expertise across multiple ICUs. Future studies should evaluate the effects of tele-ICU delirium training on patient-centered outcomes.

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Prolonged Refractory ICU Delirium Successfully Treated With Valproic Acid: Case Report and Literature Review

Journal of Pharmacy Practice ◽

10.1177/0897190020953017 ◽

2020 ◽

pp. 089719002095301

Author(s):

Bibidh Subedi ◽

Patricia R. Louzon ◽

Ahmed Masood ◽

Stephanie Recksieck

Keyword(s):

Substance Abuse ◽

Valproic Acid ◽

Acute Onset ◽

Treatment Modalities ◽

Pharmacologic Treatment ◽

Pharmacologic Agent ◽

Multiple Treatment ◽

History Of ◽

Delirium Management ◽

Icu Delirium

Intensive care unit (ICU) delirium is characterized by acute onset of cerebral dysfunction with a change or fluctuation in baseline mental status. Delirium management includes non-pharmacologic and pharmacologic treatment. However at times, alternative pharmacologic treatment is warranted. Valproic acid (VPA) is a potential pharmacologic agent that can be utilized to treat ICU delirium, though there is a paucity of evidence for its use, especially in patients with a history of substance abuse. We review the literature on VPA use in ICU delirium, and describe a challenging case of a 27-year-old female with a history of substance abuse experiencing hyperactive ICU delirium for greater than a month, refractory to multiple treatment modalities, and successfully treated with VPA therapy.

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COVID-19: ICU delirium management during SARS-CoV-2 pandemic

Critical Care ◽

10.1186/s13054-020-02882-x ◽

2020 ◽

Vol 24 (1) ◽

Cited By ~ 107

Author(s):

Katarzyna Kotfis ◽

Shawniqua Williams Roberson ◽

Jo Ellen Wilson ◽

Wojciech Dabrowski ◽

Brenda T. Pun ◽

...

Keyword(s):

Delirium Management ◽

Icu Delirium

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Correction: Current practices in ICU delirium management: a prospective multicenter study in the Netherlands

Critical Care ◽

10.1186/cc12703 ◽

2013 ◽

Vol 17 (Suppl 2) ◽

pp. P548 ◽

Cited By ~ 1

Author(s):

Z Trogrlic ◽

E Ista ◽

A Slooter ◽

H Ponssen ◽

J Schoonderbeek ◽

...

Keyword(s):

The Netherlands ◽

Multicenter Study ◽

Prospective Multicenter Study ◽

Delirium Management ◽

Icu Delirium ◽

Current Practices

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Current practices in ICU delirium management: a prospective multicenter study in the Netherlands

Critical Care ◽

10.1186/cc12333 ◽

2013 ◽

Vol 17 (S2) ◽

Author(s):

Z Trogrlic ◽

◽

E Ista ◽

A Slooter ◽

J Bakker ◽

...

Keyword(s):

The Netherlands ◽

Multicenter Study ◽

Prospective Multicenter Study ◽

Delirium Management ◽

Icu Delirium ◽

Current Practices

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Nonpharmacologic and Medication Minimization Strategies for the Prevention and Treatment of ICU Delirium: A Narrative Review

Journal of Intensive Care Medicine ◽

10.1177/0885066618771528 ◽

2018 ◽

Vol 34 (3) ◽

pp. 183-190 ◽

Cited By ~ 5

Author(s):

Gregory J. Blair ◽

Talha Mehmood ◽

Mona Rudnick ◽

Ware G. Kuschner ◽

Juliana Barr

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Recent Literature ◽

Medication Management ◽

Icu Patients ◽

Prevention And Treatment ◽

Pubmed Search ◽

Delirium Management ◽

Icu Delirium

Delirium is a multifactorial entity, and its understanding continues to evolve. Delirium has been associated with increased morbidity, mortality, length of stay, and cost for hospitalized patients, especially for patients in the intensive care unit (ICU). Recent literature on delirium focuses on specific pharmacologic risk factors and pharmacologic interventions to minimize course and severity of delirium. While medication management clearly plays a role in delirium management, there are a variety of nonpharmacologic interventions, pharmacologic minimization strategies, and protocols that have been recently described. A PubMed search was performed to review the evidence for nonpharmacologic management, pharmacologic minimization strategies, and prevention of delirium for patients in the ICU. Recent approaches were condensed into 10 actionable steps to manage delirium and minimize medications for ICU patients and are presented in this review.

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