ICU pain and delirium 2 Flashcards
what is the only benzo with some adverse hemodynamic reaction
midazolam
what should be monitored with lorazepam
serum osmolality or bicarbonate for propylene glycol toxicity
what are some adverse effects of propofol
- hypotentsion (dose dependent)
- green urine
- hypertriglyceridemia
- propofol related infusion syndrome (PRIS)
if triglycerides are greater than what, propofol should not be used?
greater than 400
increased risk of acute pancreatitis
what are the symptoms of propofol related infusion syndrome
- bradycardia
- lactic acidosis
- rhabdomyolysis
- renal failure
what should be done if propofol related infusion syndrome is suspected
stop infusion immediately
who is propofol preferred for use in
acutely agitated patients and patients requiring sedation with frequent neuro checks
what drug has sedative and mild analgesic properties with a similar mechanism to clonidine (alpha 2 agonist)
dexmedetomidine
what are some common adverse effects with dexmedetomidine
- bradycardia
- hypertension
- hypotension
- cardiac arrhythmias
when is hypotension most common with dexmedetomidine
with bolus doses
what are the 4 places in therapy noted for dexmedetomidine
- post-surgical sedation with an anticipated short inubation period
- adjunct agent to benzodiazepines
- procedural sedation
- associated with less ICU delirium
what are the two scales used for monitoring sedation
- RASS
2. Rikers
what is the target Riker score
4 on the sedation-agitation scale
what is the first line drug of choice for non-neuropathic pain in critically ill patients
IV opioids
what type of drugs are preferred for mechanically ventilated adult ICU patients
nonbenzos
propofol or dexmedetomidine
what is the definition of ICU delirium
acute change in consciousness that develops over hours to days with fluctuations in mental status
what are signs of hyperactive delirium
- irritability
- anger
- comabiveness
- laughter
what are the signs of hypoactive delirium
- slurred speech
- apathy
- lethargy
- altered sleep patterns
what are some consequences of ICU delerium
- independent risk factor of 6 month mortality
- increased length of stay
- 9x higher incidence of cognitive impairment at discharge (permanent)
what are the risk factors for ICU delirium (8)
sleep deprivation withdrawal syndromes age metabolic derangements pain drugs (opiates, benzos...) infection CNS injury
how can delirium in patients be monitored
- Confusion assemssment method
2. Intensive care delirium screening checklist
what are 5 ways of non-pharm delirium treatment
- orient patient to room and time
- give patient their eyeglasses or hearing aids if needed
- calendars and clocks
- reduce noise and distractions
- place patient in a room with a window
new practice guidelines suggest what?
- no evidence that haloperidol helps
- atypical antipsychotics may reduce duration of delirium
- dexmedetomidine infusions rather than benzos in patients unrelated to Etoh or bdz withdrawal
what are some strategies to manage pain agitation and delirium in the ICU
- daily sedation interruption or light target level of sedation in mechanically ventilated patients
- analgesia-first sedation in mechanically ventilated patients
- promoting sleep in ICU patients
- using interdisciplinary ICU teams and protocols
