DiagnosisandManagementofDeliriuminVentilatedICUPatients.pptVIP

* * * * No maximum safe dose of haloperidol is established * * * * Treatment of Hyperactive and Mixed Delirium Haloperidol is agent of choice* Best antipsychotic, few anticholinergic side-effects Unlikely to cause sedation and hypotension Typical starting dose: 1-2 mg IV every 2-4 hours Adjust for elderly and degree of agitation Can double dose every 20-30 minutes if uncontrolled -- continuous drip 5-10 mg/hr QT prolongation Cardiac monitoring at higher doses, measure K+ and Mg2+ Discontinue if QTc450ms or extrapyramidal symptoms develop American Psychiatric Association. Practice Guidelines for Treatment of Patients with Delirium. 1999. UK Clinical Pharmacy Association. Detection, Prevention and Treatment of Delirium in Critically Ill Patients. June 2006. Other Treatments for Hyperactive/Mixed Delirium Role for benzodiazepines Specifically indicated for EtOH or BZD withdrawal delirium If possible, avoid use Contribute to development of delirium Ineffective in treating delirium In ventilated patients, sedation with benzodiazepines is often necessary Treatment of Hypoactive Delirium No published data in critical care literature Antipsychotics may still play a role Treat like hyperactive delirium Stimulants such as methylphenidate may be used American Psychiatric Association. Practice Guidelines for Treatment of Patients with Delirium. 1999. UK Clinical Pharmacy Association. Detection, Prevention and Treatment of Delirium in Critically Ill Patients. June 2006. Acknowledgements and Thanks Dr. Maldonado Dr. Purtill Ngoc Nguyen, Pharm. D. SICU Team Amy Sarah Geoff Geoff Ben Thank you for listening! * * * * 274 subjects * * Act of GABA-A receptor Anxiolytic and drowsy Very high doses can lead to coma and death CNS depression is additive * Diazepam, long acting metabolites and renal excretion O2 demand increases “Ben is off with the flu” - anonymous internet source Flumazenil hepatic clearance, short half-life Increased myocardial O2 demand w/ flumazenil * 1-2 min o