Health
Mental Health
Medicine
Anxiety
Depression
Mortality
Delirium
Length of Stay
Institutionalization
Cognitive Decline
Age > 70
PreExisting Dementia
History of Delirium
VisualHearing Impairment
Functional Impairment
Polypharmacy
1/Delirium is a common problem that we see in our ICUs. It is associated with the following:
⬆️Mortality
⬆️Length of Stay
⬆️Institutionalization
⬆️Cognitive Decline
⬆️Depression, Anxiety
@VCU_PCCM @lkbrath @crit_caring_MD @PSinkam @VCU_IMRes @mdlizs @MichaeLheureux #MedEd
⬆️Mortality
⬆️Length of Stay
⬆️Institutionalization
⬆️Cognitive Decline
⬆️Depression, Anxiety
@VCU_PCCM @lkbrath @crit_caring_MD @PSinkam @VCU_IMRes @mdlizs @MichaeLheureux #MedEd
2/A snow globe is a great analogy to discuss and frame delirium with patient’s families. How well the snow is packed at the bottom of the globe can be thought of as predisposing factors. When the snow globe is shaken it represents active delirium from a precipitating cause.
3/Known predisposing factors for delirium include:
1⃣Age >70
2⃣Pre-Existing Dementia
3⃣History of Delirium
4⃣Visual/Hearing Impairment
5⃣Functional Impairment
6⃣Depression
7⃣Polypharmacy
8⃣ETOH/BZD use
@AvrahamCooperMD @aoglasser @ptfaddenMD @michellebr00ks @AdamRodmanMD
1⃣Age >70
2⃣Pre-Existing Dementia
3⃣History of Delirium
4⃣Visual/Hearing Impairment
5⃣Functional Impairment
6⃣Depression
7⃣Polypharmacy
8⃣ETOH/BZD use
@AvrahamCooperMD @aoglasser @ptfaddenMD @michellebr00ks @AdamRodmanMD
4/There are numerous precipitating causes but some of the most common seen in the ICU include:
1⃣Use of Physical Restraints
2⃣Indwelling Catheters
3⃣Polypharmacy
4⃣Electrolyte Abnormalities
5⃣Malnutrition/Dehydration
6⃣Trauma/Urgent Admission
7⃣Infection
8⃣Hypoxia
9⃣Pain
1⃣Use of Physical Restraints
2⃣Indwelling Catheters
3⃣Polypharmacy
4⃣Electrolyte Abnormalities
5⃣Malnutrition/Dehydration
6⃣Trauma/Urgent Admission
7⃣Infection
8⃣Hypoxia
9⃣Pain
5/The PADIS guidelines (2018) recommend against the routine use of antipsychotic agents in the treatment of delirium as they are NOT associated with decreased duration of delirium, mechanical ventilation, ICU LOS, or mortality. sccm.org
6/The PADIS guidelines do state that short-term use of haloperidol or atypical antipsychotic in patients may be warranted into those with significant distress from hallucinations or agitation that can be harmful to themselves or others. @mkashiouris @KevinSwiatek @gsmartinmd
7/A practical approach to the management of delirium should focus on identifying contributors to delirium:
1⃣Polypharmacy
2⃣Substance withdrawal
3⃣Respiratory Failure
4⃣Physical Restraints
5⃣Immobility
6⃣Sleep/Wake Disruption
@ktwaybill @gradydoctor @jackpenner
1⃣Polypharmacy
2⃣Substance withdrawal
3⃣Respiratory Failure
4⃣Physical Restraints
5⃣Immobility
6⃣Sleep/Wake Disruption
@ktwaybill @gradydoctor @jackpenner
8/Additionally, the ABCDEF liberation bundle is a multimodal approach to combating the adverse effects of critical illness related to acute and chronic brain dysfunction. ncbi.nlm.nih.gov
9/The ABCDEF liberation bundle focuses on the following:
1⃣Assess, Prevent, and Manage Pain
2⃣Both SAT, SBT
3⃣Choice of Analgesia/Sedation: Avoiding BZDs if able
4⃣Delirium Assessment/Prevention/Management
5⃣Early Mobility
6⃣Family Engagement
@bqueenhoo @VCUIMClerkship
1⃣Assess, Prevent, and Manage Pain
2⃣Both SAT, SBT
3⃣Choice of Analgesia/Sedation: Avoiding BZDs if able
4⃣Delirium Assessment/Prevention/Management
5⃣Early Mobility
6⃣Family Engagement
@bqueenhoo @VCUIMClerkship
10/What advice/tricks does everyone have to help manage delirium?
@vcuhospitalmed @MarkZieglerMD @EmilyKRoseMD @scall1200 @cderekleiner @rva_IntMedPD @cjchiu @ERitterMD @PDjack1984 @KatieBaxter_DO @tciden @samirashojaee @DrHowardLi1 @theandrewmac @DrMCMiles @FaridniaMasoud
@vcuhospitalmed @MarkZieglerMD @EmilyKRoseMD @scall1200 @cderekleiner @rva_IntMedPD @cjchiu @ERitterMD @PDjack1984 @KatieBaxter_DO @tciden @samirashojaee @DrHowardLi1 @theandrewmac @DrMCMiles @FaridniaMasoud
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