Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonju, Korea
Copyright © 2019 The Korean Society of Critical Care Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conceptualization: HBL. Data curation: SYP. Formal analysis: SYP. Methodology: SYP, HBL. Project administration: HBL. Visualization: SYP. Writing - original draft: SYP, HBL. Writing - review & editing: HBL.
Host factor | Acute illness | Iatrogenic and environmental factor |
---|---|---|
Age 65 years or older | Acidosis | Immobilization |
Male sex | Anemia | Medication (e.g., opioids, benzodiazepines) |
Alcoholism | Fever | |
Apolipoprotein E4 polymorphism | Infection | Anticholinergic drug |
Dementia | Sepsis | Sleep disturbance |
History of delirium | Metabolic disturbances (e.g., sodium, calcium, blood urea nitrogen, bilirubin) | |
Depression | ||
Hypertension | Respiratory distress | |
Smoking | ||
Vision or hearing impairment |
Question | Recommendation | ||
---|---|---|---|
A. Nonpharmacologic prevention and treatment | |||
Single component | |||
Should a single-component, nonpharmacologic strategy not solely focused on sleep improvement or early mobilization (vs. no such strategy) be used to reduce delirium in critically ill adults? | Committee suggests not using bright light therapy to reduce delirium in critically ill adults (conditional recommendation, moderate quality of evidence). | ||
Multicomponent | |||
Should a multicomponent, nonpharmacologic strategy (vs. no such strategy) be used to reduce delirium in critically ill adults? | Committee suggests using a multicomponent, nonpharmacologic intervention that is focused on (but not limited to) reducing modifiable risk factors for delirium, improving cognition, and optimizing sleep, mobility, hearing, and vision in critically ill adults (conditional recommendation, low quality of evidence). | ||
B. Pharmacologic prevention and treatment | |||
Should a pharmacologic agent (vs. no use of this agent) be used to “prevent” delirium in all critically ill adults? | Committee suggests not using haloperidol, an atypical antipsychotic, dexmedetomidine, a HMG-CoA reductase inhibitor (i.e., statin), or ketamine to prevent delirium in all critically ill adults (conditional recommendation, very low to low quality of evidence). | ||
Should a pharmacologic agent (vs. no use of this agent) be used to “treat subsyndromal delirium” in all critically ill adults with subsyndromal delirium? | Committee suggests not using haloperidol or an atypical antipsychotic to treat sub-syndromal delirium in critically ill adults (conditional recommendation, very low to low quality of evidence). | ||
Should a pharmacologic agent (vs. no use of this agent) be used to treat delirium in all critically ill adults with delirium? | - | ||
1. Antipsychotic/statin | Committee suggests not routinely using haloperidol, an atypical antipsychotic, or a HMG-CoA reductase inhibitor (i.e., a statin) to treat delirium (conditional recommendation, low quality of evidence). | ||
2. Dexmedetomidine | Committee suggests using dexmedetomidine for delirium in mechanically ventilated adults where agitation precludes weaning/extubation (conditional recommendation, low quality of evidence). |
HMG-CoA: β-hydroxy β-methylglutaryl-coenzyme A.