Comments on: Treatment http://www.icudelirium.co.uk Combating Delirium in ICU Patients Thu, 29 Jul 2010 21:36:13 +0000 http://wordpress.org/?v=2.6.1 By: Valerie Page http://www.icudelirium.co.uk/treatment/#comment-427 Valerie Page Thu, 15 Jul 2010 17:21:27 +0000 http://pc-01/?page_id=10#comment-427 I have no experience of using droperidol as a treatment for delirium. There is limited evidence for all the drugs used. Haloperidol itself is used mainly on the basis of case reports and series albeit large numbers of patients involved. I think if you decide not to use haloperidol to treat delirum for what ever reason then probably it would make more sense to use one from a different drug group rather than substituting droperidol. I have no experience of using droperidol as a treatment for delirium. There is limited evidence for all the drugs used. Haloperidol itself is used mainly on the basis of case reports and series albeit large numbers of patients involved. I think if you decide not to use haloperidol to treat delirum for what ever reason then probably it would make more sense to use one from a different drug group rather than substituting droperidol.

]]> By: Angee http://www.icudelirium.co.uk/treatment/#comment-424 Angee Sun, 11 Jul 2010 10:11:15 +0000 http://pc-01/?page_id=10#comment-424 How do you feel about using droperidol as treatment? How do you feel about using droperidol as treatment?

]]> By: Valerie Page http://www.icudelirium.co.uk/treatment/#comment-337 Valerie Page Fri, 22 Jan 2010 15:17:18 +0000 http://pc-01/?page_id=10#comment-337 Sorry for the delay in answering! The dose of haloperidol has never been firmly established. The dose required to block the dopamine receptors at the optimum 60% is very variable. Very broadly care of the elderly physicians and psychiatrists do use lower doses than ICU physicians and palliative care consultants. Maybe because for these patients time is not on our side? Among UK consultant intensivists 2.5mgs iv is the standard dose. (Historically very large doses have been used in ICU - 480mgs/24 hours (not now!)). Finally enteral haloperidol causes more EPS than iv. Sorry for the delay in answering! The dose of haloperidol has never been firmly established. The dose required to block the dopamine receptors at the optimum 60% is very variable. Very broadly care of the elderly physicians and psychiatrists do use lower doses than ICU physicians and palliative care consultants. Maybe because for these patients time is not on our side? Among UK consultant intensivists 2.5mgs iv is the standard dose. (Historically very large doses have been used in ICU - 480mgs/24 hours (not now!)). Finally enteral haloperidol causes more EPS than iv.

]]> By: kishore http://www.icudelirium.co.uk/treatment/#comment-321 kishore Thu, 31 Dec 2009 13:22:44 +0000 http://pc-01/?page_id=10#comment-321 The dose of haloperidol, according to recent advice by elderly care physicians is 0.5 to 1mg rather than 2-5 mg as suggested. I am not an expert on pharmacology, delirium or ITU care. So I am not finding fault with you but asking your present opinion. I have a practical experience of treating 2 elderly patients with haloperidol (in last 3 months )- 2 mg given on both occasions and both the pateints are 72 yr old. Both of them developed increasing confusion, motor spasms(involuntary), and other extrapyramidal symptoms!!! with single dose. Both of them were in general wards, with 1-2 predisposing factors. kishore. The dose of haloperidol, according to recent advice by elderly care physicians is 0.5 to 1mg rather than 2-5 mg as suggested. I am not an expert on pharmacology, delirium or ITU care. So I am not finding fault with you but asking your present opinion.

I have a practical experience of treating 2 elderly patients with haloperidol (in last 3 months )- 2 mg given on both occasions and both the pateints are 72 yr old. Both of them developed increasing confusion, motor spasms(involuntary), and other extrapyramidal symptoms!!! with single dose. Both of them were in general wards, with 1-2 predisposing factors.

kishore.

]]> By: Valerie Page http://www.icudelirium.co.uk/treatment/#comment-258 Valerie Page Mon, 09 Nov 2009 15:35:13 +0000 http://pc-01/?page_id=10#comment-258 I am sure the presence of a loved one helps when orientating a patient. Even a familiar nurse is considered important. Environmental factors include not too much or little stimulation! It is also important to allow patients to talk about the nightmares which are very common and commonly distressing but maybe less so when explained as part of a delirious episode. I am sure the presence of a loved one helps when orientating a patient. Even a familiar nurse is considered important. Environmental factors include not too much or little stimulation!
It is also important to allow patients to talk about the nightmares which are very common and commonly distressing but maybe less so when explained as part of a delirious episode.

]]> By: Jill Sanders http://www.icudelirium.co.uk/treatment/#comment-239 Jill Sanders Fri, 30 Oct 2009 11:43:37 +0000 http://pc-01/?page_id=10#comment-239 What impact can the reassurance of the familiar have in cases of ICU delirium? Do voices and touches of loved ones help? This has recently been happening to my dear partner and the ICU staff at St George's Hospital in Tooting welcomed my presence and felt such reassurance was a positive influence as John emerged from emergency surgery and many days of sedation. He has been able to briefly articulate some terrible nightmares and I feel that my being there has been a helpful influence in his being able to begin to rationalise them. What impact can the reassurance of the familiar have in cases of ICU delirium? Do voices and touches of loved ones help? This has recently been happening to my dear partner and the ICU staff at St George’s Hospital in Tooting welcomed my presence and felt such reassurance was a positive influence as John emerged from emergency surgery and many days of sedation. He has been able to briefly articulate some terrible nightmares and I feel that my being there has been a helpful influence in his being able to begin to rationalise them.

]]>