Use of antipsychotics for the treatment of intensive care unit delirium - Critical Care Science (CCS)
Intensivists are faced on a daily basis with patients suffering from delirium, which causes them and their loved ones considerable distress and predicts for those patients worse outcomes, including dementia and death. With the use of routine screening tools delirium is now identified in patients previously thought to be still under the effects of sedation, depressed, simply difficult or overly compliant. World-wide studies document the prevalence of intensive care unit (ICU) delirium as ranging from 30% to 80%.() Studies using patients’ computerised tomography and magnetic resonance brain scans hypothesize a link between duration of delirium and brain atrophy.() While the pathophysiology of delirium is still not entirely understood, there is certainly evidence to support the hypothesis of a final common pathway of an ongoing hyperdopaminergic and hypocholinergic state perhaps triggered by oxidative stress and associated with excitotoxicity.()
Put together the diagnosis of a syndrome known to be associated with harm and a basis for ongoing neurotransmitter imbalance it is inevitable that clinicians would use an antipsychotic intervention with the aim of rapid resolution. An educational workshop on attitudes towards pharmacotherapy for delirium resulted in a more positive general attitude to pharmacological interventions, especially in hypoactive presentations and prophylactically in high-risk patients.()
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Intensivists are faced on a daily basis with patients suffering from delirium, which causes them and their loved ones considerable distress and predicts for those patients worse outcomes, including dementia and death. With the use of routine screening tools delirium is now identified in patients previously thought to be still under the effects of sedation, depressed, simply difficult or overly compliant. World-wide studies document the prevalence of intensive care unit (ICU) delirium as ranging from 30% to 80%.() Studies using patients' computerised tomography and magnetic resonance brain scans hypothesize a link between duration of delirium and brain atrophy.() While the pathophysiology of delirium is still not entirely understood, there is certainly evidence to support the hypothesis of a final common pathway of an ongoing hyperdopaminergic and hypocholinergic state perhaps triggered by oxidative stress and associated with excitotoxicity.()
Put together the diagnosis of a syndrome known to be associated with harm and a basis for ongoing neurotransmitter imbalance it is inevitable that clinicians would use an antipsychotic intervention with the aim of rapid resolution. An educational workshop on attitudes towards pharmacotherapy for delirium resulted in a more positive general attitude to pharmacological interventions, especially in hypoactive presentations and prophylactically in high-risk patients.()
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