ICU Cases · Delirium & sleep
ICU delirium — the prevention and the management pathway
A long case on the ICU delirium — the CAM-ICU screening, the cause search (the infection, the hypoxia, the metabolic), the prevention bundle, and the dexmedetomidine for the drug management.
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CICMFFICMEDIC
Prompt
A 75-year-old man on day 3 of a severe pneumonia becomes acutely confused and agitated. Outline the assessment and the management.
Presentation
A 75-year-old man, on day 3 of a severe pneumonia, becomes acutely confused, agitated, and pulls at his lines. The CAM-ICU is positive. The midazolam infusion was uptitrated to control the agitation but the confusion has worsened. The nurse asks for the management.
References3ShowHide
- [1]van den Boogaard M, Schoonhoven L, van der Hoeven JG, et al. Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial. JAMA, 2018.PMID 29466591
- [2]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [3]Stollings JL, Kotfis K, Chanques G, et al. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Med, 2021.PMID 34401939