Before you decide your patient has #DICU,
Consider the differential:
🧠 CNS/psych path/lesions: bleed/stroke/seizure/dementia/depression
💥 Tox/metabolic causes: Na/substance/withdrawal/Glu/Meds (BZD)/O2
🤒 Infections: meningoenceph/UTI/sepsis
👹 Organ failures
IMO they are ALL at risk.
They all DESERVE delirium prevention.
Meds: Data DOES NOT support using antipsychotics!
Su (2016): Dex reduces delirium vs placebo (77% vs 32%): bit.ly/2UZVJOA
n = 50, but still a neat idea.
W/ some data supporting improvement in sleep physiology, we may have a new tool, but more to come!
💉 STOP offending meds (BZDs, antihistaminics, etc)
😴 SLEEP at NIGHT!
🏃♀️Mobility during day
💩 5Ps: Poop (constipation), Pee (urinary retention), Pain, Positioning, Presence (meaningful contact: TALK TO THEM!)
Antipsychotics don't seem to work (see slide)
Early, tiny bit of data for using Dex (it's the new star!): DahLIA study
MIND-USA (2018): no diff in delirium free days: Haldol vs ziprasidone vs placebo. H/T @timothygirard for nicely done study, sharing his insight!