"improving intensive care in Scotland"

Delirium in ICU

Pharmacological treatments

  • Assess the need for all current medications, especially sedatives, analgesics and anticholinergic drugs
  • Daily sedations breaks to titrate appropriate sedative/analgesic requirements
  • Adequate analgesia will reduce risk of delirium if pain is a problem

Benzodiazepines are useful in treatment of delirium secondary to alcohol withdrawal (delirium tremens) but should otherwise be avoided as they may worsen symptoms.

The Society of Critical Care Medicine recommends Haloperidol for the treatment of delirium, although there is little evidence to support its use. Start with a low dose and titrate to effect (e.g. 2.5 mg, doubling the dose as required every 20-30 minutes). Consider regular dosing to control symptoms.

The use of antipsychotic agents in the hypoactive form of delirium is controversial.

Haloperidol

A dopamine receptor antagonist which inhibits dopamine neurotransmission, thus causing improvement in positive symptomatology (i.e. hallucinations, agitation) whilst simultaneously providing sedation. Adverse effects include prolongation of the QT interval and extrapyramidal side effects.

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