Pharmacologic Management of Intensive Care Unit Delirium: Clinical Prescribing Practices and Outcomes in More Than 8500 Patient Encounters

2021 ◽  
Author(s):  
Christina S. Boncyk ◽  
Emily Farrin ◽  
Joanna L. Stollings ◽  
Kelli Rumbaugh ◽  
Jo Ellen Wilson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prescribing Practices ◽  
Pharmacologic Management ◽  
Intensive Care Unit Delirium

scholarly journals The effect of non-pharmacologic strategies on prevention or management of intensive care unit delirium: a systematic review

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1178
Author(s):  
Julie S Cupka ◽  
Haleh Hashemighouchani ◽  
Jessica Lipori ◽  
Matthew M. Ruppert ◽  
Ria Bhaskar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Management Strategies ◽  
Early Mobility ◽  
Mobility Studies ◽  
Full Text Review ◽  
Pharmacologic Management ◽  
Intensive Care Unit Delirium ◽  
The Relationship

Background: Post-operative delirium is a common complication among adult patients in the intensive care unit. Current literature does not support the use of pharmacologic measures to manage this condition, and several studies explore the potential for the use of non-pharmacologic methods such as early mobility plans or environmental modifications. The aim of this systematic review is to examine and report on recently available literature evaluating the relationship between non-pharmacologic management strategies and the reduction of delirium in the intensive care unit. Methods: Six major research databases were systematically searched for articles analyzing the efficacy of non-pharmacologic delirium interventions in the past five years. Search results were restricted to adult human patients aged 18 years or older in the intensive care unit setting, excluding terminally ill subjects and withdrawal-related delirium. Following title, abstract, and full text review, 27 articles fulfilled the inclusion criteria and are included in this report. Results: The 27 reviewed articles consist of 12 interventions with a single-component investigational approach, and 15 with multi-component bundled protocols. Delirium incidence was the most commonly assessed outcome followed by duration. Family visitation was the most effective individual intervention while mobility interventions were the least effective. Two of the three family studies significantly reduced delirium incidence, while one in five mobility studies did the same. Multi-component bundle approaches were the most effective of all; of the reviewed studies, eight of 11 bundles significantly improved delirium incidence and seven of eight bundles decreased the duration of delirium. Conclusions: Multi-component, bundled interventions were more effective at managing intensive care unit delirium than those utilizing an approach with a single interventional element. Although better management of this condition suggests a decrease in resource burden and improvement in patient outcomes, comparative research should be performed to identify the importance of specific bundle elements.

scholarly journals The effect of non-pharmacologic strategies on prevention or management of intensive care unit delirium: a systematic review

F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 1178
Author(s):  
Julie S Cupka ◽  
Haleh Hashemighouchani ◽  
Jessica Lipori ◽  
Matthew M. Ruppert ◽  
Ria Bhaskar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Management Strategies ◽  
Early Mobility ◽  
Mobility Studies ◽  
Full Text Review ◽  
Pharmacologic Management ◽  
Intensive Care Unit Delirium ◽  
The Relationship

Background: Post-operative delirium is a common complication among adult patients in the intensive care unit. Current literature does not support the use of pharmacologic measures to manage this condition, and several studies explore the potential for the use of non-pharmacologic methods such as early mobility plans or environmental modifications. The aim of this systematic review is to examine and report on recently available literature evaluating the relationship between non-pharmacologic management strategies and the reduction of delirium in the intensive care unit. Methods: Six major research databases were systematically searched for articles analyzing the efficacy of non-pharmacologic delirium interventions in the past five years. Search results were restricted to adult human patients aged 18 years or older in the intensive care unit setting, excluding terminally ill subjects and withdrawal-related delirium. Following title, abstract, and full text review, 27 articles fulfilled the inclusion criteria and are included in this report. Results: The 27 reviewed articles consist of 12 interventions with a single-component investigational approach, and 15 with multi-component bundled protocols. Delirium incidence was the most commonly assessed outcome followed by duration. Family visitation was the most effective individual intervention while mobility interventions were the least effective. Two of the three family studies significantly reduced delirium incidence, while one in five mobility studies did the same. Multi-component bundle approaches were the most effective of all; of the reviewed studies, eight of 11 bundles significantly improved delirium incidence and seven of eight bundles decreased the duration of delirium. Conclusions: Multi-component, bundled interventions were more effective at managing intensive care unit delirium than those utilizing an approach with a single interventional element. Although better management of this condition suggests a decrease in resource burden and improvement in patient outcomes, comparative research should be performed to identify the importance of specific bundle elements.

Different assessment tools for intensive care unit delirium: Which score to use?*

2010 ◽  
Vol 38 (2) ◽  
pp. 409-418 ◽  
Author(s):  
Alawi Luetz ◽  
Anja Heymann ◽  
Finn M. Radtke ◽  
Chokri Chenitir ◽  
Ulrike Neuhaus ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Assessment Tools ◽  
Intensive Care Unit Delirium

scholarly journals Intensive Care Unit Delirium

2016 ◽  
Vol 125 (6) ◽  
pp. 1229-1241 ◽  
Author(s):  
Christina J. Hayhurst ◽  
Pratik P. Pandharipande ◽  
Christopher G. Hughes
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prevention And Treatment ◽  
Intensive Care Unit Delirium

This review examines the most recent evidence for the diagnosis, prevention, and treatment of delirium in the ICU.

scholarly journals Drug utilization pattern of antimicrobials in intensive care unit of a tertiary care teaching hospital

2020 ◽  
Vol 9 (10) ◽  
pp. 1594
Author(s):  
Saswat Satapathy ◽  
Yajnesh P. Sahu ◽  
Ashok K. Panigrahi ◽  
Bhabagrahi Rath ◽  
Ananta N. Patra
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Drug Utilization ◽  
Drug Prescription ◽  
Tertiary Care ◽  
Quality Of Healthcare ◽  
Cross Sectional Study ◽  
Utilization Pattern ◽  
Prescribing Practices ◽  
Cross Sectional

Background: The intensive care unit is a setting where the multiple medications are prescribed to patients. Antimicrobials are heavily prescribed in the ICUs, which in turn enhance the risk of antimicrobial resistance, increase the side effects and increases the cost of treatment. Drug utilization study is a component of medical auditing that aims to monitor and evaluate the drug prescription patterns and to suggest necessary modifications in the prescribing practices to achieve rational therapeutic practice.Methods: A cross-sectional study was conducted in which data of patients admitted to ICU during the period from June 2019 to August 2019 was collected from the Medical Record Section of the hospital. Drug utilization pattern of antimicrobials in ICU was analyzed.Results: Out of 90 patients, 60 were males and 30 were females. The average duration of stay in ICU was 7.53 days. The most common antibiotic prescribed was ceftriaxone followed by piperacillin and tazobactam with DDD/100 bed days of 24.2 and 17.3 respectively.Conclusions: In this study, the results appeared to be similar to those reported in previous studies. However, prescription protocols need to be addressed to guide appropriate use of antimicrobials in the ICU setting. Therefore, it is necessary to conduct drug utilization research to understand the drug consumption and for implementation of protocols to improve the quality of healthcare. 

Prescribing Practices of Valproic Acid for Agitation and Delirium in the Intensive Care Unit

2020 ◽  
pp. 106002802094717
Author(s):  
Nicholas J. Quinn ◽  
Benjamin Hohlfelder ◽  
Matthew R. Wanek ◽  
Abhijit Duggal ◽  
Heather Torbic
Keyword(s):  
Intensive Care Unit ◽  
Valproic Acid ◽  
Intensive Care ◽  
Primary Objective ◽  
Assessment Tools ◽  
Prescribing Practices ◽  
Dose Frequency ◽  
Institutional Review ◽  
Alternative Treatment Option ◽  
Icu Delirium

Background: Analgesics, sedatives, and antipsychotics are commonly prescribed for agitation and delirium in the intensive care unit (ICU), but their use is limited by adverse effects and lack of efficacy. Valproic acid is an alternative treatment option. Objective: The primary objective of this study was to describe valproic acid prescribing in our institution’s ICUs when used for agitation or delirium. Measures of effectiveness and safety were also assessed. Methods: This was a single-center, retrospective, institutional review board–approved cohort study of adult inpatients admitted to the ICU between January 2018 and August 2018. Patients who received valproic acid for the treatment of agitation or delirium for ≥24 hours were included. Prescribing practices were evaluated for dose, frequency, and route of administration. Effectiveness was assessed via agitation and delirium assessment tools and quantity of adjunctive agents used. Results: A total of 80 patients were included, with 35 receiving valproic acid alone and 45 in conjunction with antipsychotics. The most common valproic acid regimen was 250 mg orally 3 times daily. Delirium resolution occurred in 55% of patients: 24 in the valproic acid monotherapy group and 20 in the valproic acid plus antipsychotic group (69% vs 44%; P = 0.03). The incidence of delirium decreased from valproic acid day 0 to day 3 (93% vs 68%; P < 0.01), with no change in agitation (64% vs 63%; P = 0.28). Conclusion and Relevance: Valproic acid is frequently prescribed in agitated, delirious patients at our institution and may have a role in the management of ICU delirium.

Discharge from hospital with newly administered antipsychotics after intensive care unit delirium – Incidence and contributing factors

2021 ◽  
Vol 61 ◽  
pp. 162-167
Author(s):  
Johannes Lambert ◽  
Joris Vermassen ◽  
Jan Fierens ◽  
Harlinde Peperstraete ◽  
Mirko Petrovic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Contributing Factors ◽  
Intensive Care Unit Delirium ◽  
Discharge From Hospital
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