Treatment - A Step Wise Approach
The most important step in delirium management is early recognition. If a diagnosis of delirium is not made, we then run the risk of simply masking the signs rather than addressing the true underlying cause. Once it has been established that the patient is delirious, a thorough investigation of potential underlying causes is critical.
In the prevention and treatment of delirium the first focus should be to minimize and or eliminate any predisposing or precipitating factors.
Often predisposing risk factors such as age and pre-admission cognitive status are not possible to change, however, things such as proper nutrition and mobility can be corrected.
As for precipitating factors, sedative use is one of the most common modifiable risk factors. Narcotics and benzodiazepines are often used to help with sedation and pain management, which may seem to be addressing some of the delirium risk factors. However, their use in and of themselves can precipitate the onset of delirium as well.
In some cases, a sudden onset of delirium can be a sign of an underlying infection or hemodynamic instability. If this the case, appropriate therapy for the offending cause should be started.
If there is no modifiable underlying etiology or the patient's symptoms are severe and interfering with treatment, pharmacological management should be considered.
For a more detailed algorithm on the treatment of delirium, the Vanderbilt University Medical Center has a Delirium Protocol that can be found below.
In the prevention and treatment of delirium the first focus should be to minimize and or eliminate any predisposing or precipitating factors.
Often predisposing risk factors such as age and pre-admission cognitive status are not possible to change, however, things such as proper nutrition and mobility can be corrected.
As for precipitating factors, sedative use is one of the most common modifiable risk factors. Narcotics and benzodiazepines are often used to help with sedation and pain management, which may seem to be addressing some of the delirium risk factors. However, their use in and of themselves can precipitate the onset of delirium as well.
In some cases, a sudden onset of delirium can be a sign of an underlying infection or hemodynamic instability. If this the case, appropriate therapy for the offending cause should be started.
If there is no modifiable underlying etiology or the patient's symptoms are severe and interfering with treatment, pharmacological management should be considered.
For a more detailed algorithm on the treatment of delirium, the Vanderbilt University Medical Center has a Delirium Protocol that can be found below.
![](http://www.weebly.com/weebly/images/file_icons/pdf.png)
delirium_protocol.pdf | |
File Size: | 85 kb |
File Type: |
Copyright © 2002, E. Wesley Ely, MD, MPH and Vanderbilt University, all rights reserved