Comments on: Treatment http://www.icudelirium.co.uk Combating Delirium in ICU Patients Sat, 04 Feb 2012 23:51:04 +0000 http://wordpress.org/?v=2.6.1 By: Valerie Page http://www.icudelirium.co.uk/treatment/#comment-9127 Valerie Page Tue, 17 Jan 2012 11:35:56 +0000 http://pc-01/?page_id=10#comment-9127 Thanks Dee, personal stories are always powerful when trying to convince ICU clinicians of the importance of delirium. Patients sometimes worry about the stigma associated with what is an essentially psychotic episode, more so if it was traumatic. The more light patients shine on the dark face of delirium by sharing their experiences the better for all. We welcome contributions from patients to the Annals of Delirium, a European newsletter - contact valerie.page@whht.nhs.uk Good luck! Thanks Dee, personal stories are always powerful when trying to convince ICU clinicians of the importance of delirium. Patients sometimes worry about the stigma associated with what is an essentially psychotic episode, more so if it was traumatic. The more light patients shine on the dark face of delirium by sharing their experiences the better for all.
We welcome contributions from patients to the Annals of Delirium, a European newsletter - contact valerie.page@whht.nhs.uk
Good luck!

]]> By: Dee Serame http://www.icudelirium.co.uk/treatment/#comment-9075 Dee Serame Thu, 12 Jan 2012 00:57:43 +0000 http://pc-01/?page_id=10#comment-9075 Nice work Dr Page. Over the past ten years I've had three open heart surguries, one followed by a month long coma, another preceded by a minor stroke. I have short term memory deficits which now makes me unable to continue a software engineering carreer. During the worst operation I remember a horrible experience of flashing lights and a horrid machine noise - just as a Josefina described. This was followed by a nightmare about being imprisoned by Homeland Security. Things did get better, I was released (escaped?) from the desert prison and I built a golf course next to the base. I woke up a month later. I was told I was combative, had to be restrained, then put in an induced coma. Horrible experience, happy ending. Regards, Dee Nice work Dr Page. Over the past ten years I’ve had three open heart surguries, one followed by a month long coma, another preceded by a minor stroke. I have short term memory deficits which now makes me unable to continue a software engineering carreer.

During the worst operation I remember a horrible experience of flashing lights and a horrid machine noise - just as a Josefina described. This was followed by a nightmare about being imprisoned by Homeland Security.

Things did get better, I was released (escaped?) from the desert prison and I built a golf course next to the base. I woke up a month later. I was told I was combative, had to be restrained, then put in an induced coma.

Horrible experience, happy ending.

Regards, Dee

]]> By: Said http://www.icudelirium.co.uk/treatment/#comment-8277 Said Fri, 11 Nov 2011 16:40:30 +0000 http://pc-01/?page_id=10#comment-8277 Hello, Hi, Hey, great article, post, blog, I, we love, like, loved, liked it !!! Hello, Hi, Hey, great article, post, blog, I, we love, like, loved, liked it !!!

]]> By: Valerie Page http://www.icudelirium.co.uk/treatment/#comment-7689 Valerie Page Thu, 06 Oct 2011 15:29:50 +0000 http://pc-01/?page_id=10#comment-7689 I wish you well with implementing the CAM-ICU and RASS, once the staff see the benefits (and they will) then it will become second nature at the very least to think about a patients mental status. Hypoactive delirium is a difficult one - to give drugs or not to give drugs that is the question. First of course when it comes to delirium find the cause, it is always precipitated by something. Some of the causes are easier to deal with than others - infection or steroid drugs are easier to manage than hyponatraemia. Treat any treatable cause and there may be more than one, treat them all. You can consider giving an antipsychotic if you believe the delirium is hindering clinical progress (eg not able to extubate because of inability to cough or co-operate with physio) but you need to balance that against side effects. If I am treating I use haloperidol if not contraindicated (long QT, Parkinsons) and I give half the dose e.g. 1.25mgs. There is no robust evidence for this but that is generally the practice for clinicians who use antipsychotics in hypoactive delirium. Good luck! I wish you well with implementing the CAM-ICU and RASS, once the staff see the benefits (and they will) then it will become second nature at the very least to think about a patients mental status.
Hypoactive delirium is a difficult one - to give drugs or not to give drugs that is the question. First of course when it comes to delirium find the cause, it is always precipitated by something. Some of the causes are easier to deal with than others - infection or steroid drugs are easier to manage than hyponatraemia. Treat any treatable cause and there may be more than one, treat them all.
You can consider giving an antipsychotic if you believe the delirium is hindering clinical progress (eg not able to extubate because of inability to cough or co-operate with physio) but you need to balance that against side effects. If I am treating I use haloperidol if not contraindicated (long QT, Parkinsons) and I give half the dose e.g. 1.25mgs. There is no robust evidence for this but that is generally the practice for clinicians who use antipsychotics in hypoactive delirium.
Good luck!

]]> By: lorraine reidy http://www.icudelirium.co.uk/treatment/#comment-7253 lorraine reidy Wed, 14 Sep 2011 18:58:12 +0000 http://pc-01/?page_id=10#comment-7253 Dear Dr Valerie Page, I ahve been interested in delirium for several years now and the itu that i work in have several team members that are also keen to implement the CAM-icu and the RASS as recommended by the NICE GUIDELINES july 2010 Delirium. We are currently sharing information regarding Delirium within the Unit and hopefully to commence the RASS and CAM icu in October 2011. Although from the comments previously regarding Haloperidol and sitting with the patient when agitated and ensuring other causes are addressed e.g pain, infection, environment. what is your advice for the patient that is hypoactive what are the best ways to manage these patients as these are the patients that are at a higher risk of experiencing the negative aspects of delirium such as longer hospital stays, higher mortality, residential care. I shall look forward to your reply. Thank you for your time to read this post. Lorraine Dear Dr Valerie Page,

I ahve been interested in delirium for several years now and the itu that i work in have several team members that are also keen to implement the CAM-icu and the RASS as recommended by the NICE GUIDELINES july 2010 Delirium.

We are currently sharing information regarding Delirium within the Unit and hopefully to commence the RASS and CAM icu in October 2011.
Although from the comments previously regarding Haloperidol and sitting with the patient when agitated and ensuring other causes are addressed e.g pain, infection, environment.
what is your advice for the patient that is hypoactive what are the best ways to manage these patients as these are the patients that are at a higher risk of experiencing the negative aspects of delirium such as longer hospital stays, higher mortality, residential care.

I shall look forward to your reply.

Thank you for your time to read this post.

Lorraine

]]> By: Tobar http://www.icudelirium.co.uk/treatment/#comment-936 Tobar Sun, 09 Jan 2011 18:03:43 +0000 http://pc-01/?page_id=10#comment-936 Great blog! Keep it up Great blog!
Keep it up

]]> By: kredyt hipoteczny http://www.icudelirium.co.uk/treatment/#comment-822 kredyt hipoteczny Thu, 23 Dec 2010 18:23:17 +0000 http://pc-01/?page_id=10#comment-822 Looks nice. Happy to read that:) Looks nice. Happy to read that:)

]]> By: zielona herbata http://www.icudelirium.co.uk/treatment/#comment-726 zielona herbata Mon, 06 Dec 2010 19:33:28 +0000 http://pc-01/?page_id=10#comment-726 Thank You for sharing! Really great:) Thank You for sharing! Really great:)

]]> By: Aslam http://www.icudelirium.co.uk/treatment/#comment-625 Aslam Sat, 06 Nov 2010 09:49:46 +0000 http://pc-01/?page_id=10#comment-625 Always interesting to follow annice website. Thank you for the post. In addition, apart from the content , the design of your blog looks really amazing . Cheers. Always interesting to follow annice website. Thank you for the post. In addition, apart from the content , the design of your blog looks really amazing . Cheers.

]]> By: Valerie Page http://www.icudelirium.co.uk/treatment/#comment-587 Valerie Page Fri, 22 Oct 2010 12:16:33 +0000 http://pc-01/?page_id=10#comment-587 Dear Lars - OK currently I generally don't work in 24 periods when managing agitated delirium but to give you an answer I (personally) do not tend to go above 20mgs intravenously in a 24 hour period (but would give that over 2 hours if necessary if that makes sense) mainly because I believe if 20mgs has not settled the agitation then I need to try a different strategy. (The British National Fomulary recommends no more than 18mgs iv and companies are withdrawing the intravenous license) The evidence for haloperidol working is limited to large case series, case reports and a couple of small RCTs only one of which was run to good research standards. There is much less published on other antipsychotics and most are comparing one with another or haloperidol. Regarding doses there is evidence from PET scans that much lower doses of haloperidol saturate the receptors and that our practice in ICU is heavy handed to say the least. Here at Watford we are about to embark on a trial which we hope (expect) to add to our knowledge on the clinical effectiveness of haloperidol - not before time. V Dear Lars -
OK currently I generally don’t work in 24 periods when managing agitated delirium but to give you an answer I (personally) do not tend to go above 20mgs intravenously in a 24 hour period (but would give that over 2 hours if necessary if that makes sense) mainly because I believe if 20mgs has not settled the agitation then I need to try a different strategy. (The British National Fomulary recommends no more than 18mgs iv and companies are withdrawing the intravenous license)
The evidence for haloperidol working is limited to large case series, case reports and a couple of small RCTs only one of which was run to good research standards. There is much less published on other antipsychotics and most are comparing one with another or haloperidol. Regarding doses there is evidence from PET scans that much lower doses of haloperidol saturate the receptors and that our practice in ICU is heavy handed to say the least.
Here at Watford we are about to embark on a trial which we hope (expect) to add to our knowledge on the clinical effectiveness of haloperidol - not before time. V

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