Pain Management: Delirium

Question 1

Delirium definition

Answer 1

acute changes in mental status with inattention, disorganized thinking, and altered level of consciousness not explained by pre-existing conditions

Question 2

Modifiable risk factors for delirium

Answer 2

BZD use, blood transfusions

Question 3

Nonmodifiable risk factors for delirium

Answer 3

increased age, dementia history, prior coma, pre-ICU emergency surgery/trauma, increased APACHE score

Question 4

Screening tools for delirium

Answer 4

CAM-ICU: reported as positive or negative delirium
ICDSC: score ≥4 suggests delirium

Question 5

Nonpharm interventions for delirium

Answer 5

Re-orient the patient
Use of hearing aids or glasses
Limit noise and light at night (ear plugs, noise-canceling headphones)
Encourage natural sleep-wake cycle
Reduce nursing care at night (for sleep)
Early mobilization
Family presence
Music therapy
Limit use of BZDs and anticholinergic medications

Question 6

Pharmacologic options for delirium

Answer 6

Guidelines don’t recommend them, but here are some ideas:

Opioids, Precedex, melatonin-receptor agonists, APS (quetiapine, haloperidol, olanzapine)

Question 7

Guidelines about Precedex and delirium

Answer 7

Use Precedex for delirium in mechanically ventilated adults where agitation is precluding weaning/extubation