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Delirium & Sedation

Delirium & Sedation. Nov 2013. Outline. Definition, incidence & prognosis Causes Assessment Treatment Sedation. Definition. Acute change in mental status with a fluctuating course, characterized by inattention and disorganized thinking Brain failure, part of MOF

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Delirium & Sedation

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  1. Delirium & Sedation Nov 2013

  2. Outline • Definition, incidence & prognosis • Causes • Assessment • Treatment • Sedation

  3. Definition • Acute change in mental status with a fluctuating course, characterized by inattention and disorganized thinking • Brain failure, part of MOF • Hyperactive/Hypoactive/Mixed

  4. Incidence & prognosis • 15-80% of critically ill patients • Easily missed • Up to 3x increased mortality • Increased days ventilated/length of stay • Long term cognitive impairment

  5. Causes • Iatrogenic • Sleep disturbance • Pain • Sepsis/hypoxia/electrolytes etc • Pre-existing cognitive problems • Drugs • Legal and illegal • Alcohol

  6. Assessment • CAM-ICU • Richmond Agitation Sedation Score • Don’t miss an alternative diagnosis • CVA • Intracranial bleed • Thyroid disease • Psychiatric disease

  7. Treatment • General & non-pharmacological • Treat organic problems inc withdrawal • Good nursing & orientation • Day-night cycle protection • Glasses/hearing aids • Pharmacological • Haloperidol • Olanzapine • α agonists • Trazadone • No benzodiazepines & watch out for long qt

  8. Sedation – why? • Airway protection • Mechanical ventilation • Haemodynamic stability • To facilitate patient care • Other procedures – endoscopy, interventional radiology, sengstaken

  9. Sedation • Propofol/fentanyl unit standard • Alfentanil/remifentanil • Morphine & midazolam • Paediatrics • Propofol infusion syndrome • Thiopentone • Status epilepticus • Raised ICP • Dexmedetomidine

  10. Sedation • Daily sedation hold if at all feasible • Aim is RASS 0 to -2 • Nurses vs doctors • Don’t forget analgesia or local anaesthesia • PTSD

  11. Summary • Definition & importance of delirium • Causes • Assessment and treatment • Methods and aims of sedation

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