Delirium and use of sedation agents in intensive care.
OBJECTIVE
The aim of the review was to consider the relationship between delirium and aspects of sedative and analgesic drug use in mechanically ventilated intensive care patients. The basis for routine delirium screening and the implications for nurses are discussed along with a brief outline of the treatment of delirium.


BACKGROUND
Delirium is common in intensive care patients and like other markers of organ failure is associated with worse outcomes. The risk of developing delirium is dependent on the patients' individual vulnerability and on the burden of precipitating factors they are exposed to. Detection of delirium in intensive care patients is often difficult and requires the regular use of a validated screening tool. Intensive care patients are exposed to multiple delirium risk factors, and sedative and analgesic agents present an important subgroup, which we can attempt to control. Sedative and analgesic drug choice, their mode of administration, monitoring and titration have consequences for delirium development.


METHODS
Literature review.


CONCLUSIONS
Sedative and analgesic drugs have an important role in the prevention and treatment of delirium in intensive care patients. Routine delirium screening should be included as part of sedation monitoring practice. When detected, treatment is focused on the prompt correction of precipitating factors, non-pharmacological interventions and appropriate drug therapy for symptom control.
Bourne
Richard S
RS
Critical Care Department, Sheffield Teaching Hospitals, Sheffield, UK. richard.bourne@sth.nhs.uk
D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D003422:Critical Care / Q000458:organization & administration*; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003951:Diagnostic Errors; D016903:Drug Monitoring / Q000451:nursing; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008403:Mass Screening; D009017:Morbidity; D024802:Nurse's Role; D009730:Nursing Assessment / Q000458:organization & administration*; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D010348:Patient Care Team; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D012121:Respiration, Artificial / Q000009:adverse effects / Q000451:nursing; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control
D000700:Analgesics; D006993:Hypnotics and Sedatives