Pharmacological Options for Treating Delirium in Critically Ill Adults

Pharmacological Options for Treating Delirium in Critically Ill Adults

Pharmacological Options for Treating Delirium in Critically Ill Adults

Editor’s note: The mission of Cochrane Nursing is to provide an international evidence base for nurses involved in delivering, leading, or researching nursing care. Cochrane Corner provides summaries of recent systematic reviews from the Cochrane Library. For more information, see .

Don't use plagiarized sources. Get Your Custom Essay on
Pharmacological Options for Treating Delirium in Critically Ill Adults
From $10/Page
Order Essay
REVIEW QUESTION

What are the safety and effectiveness of pharmacological options for treating delirium in critically ill adults?  Pharmacological Options for Treating Delirium in Critically Ill Adults

TYPE OF REVIEW

A systematic review of 14 randomized controlled trials (RCTs), including 1,844 participants.

RELEVANCE FOR NURSING

Delirium, defined as a reversible nonspecific cognitive impairment, is commonly seen in critically ill adults and is associated with many negative outcomes. Those outcomes may include increased mortality, prolonged mechanical ventilation, and increased length of stay (in the ICU and/or the hospital), as well as long-term consequences such as ongoing cognitive impairment and need for long-term care. Delirium and its outcomes can be traumatic for patients and their caregivers, and also carry a significant economic burden. Pharmacological Options for Treating Delirium in Critically Ill Adults

CHARACTERISTICS OF THE EVIDENCE

The goal of this review was to compare pharmacological interventions for the treatment of delirium in critically ill adults either with delirium or at high risk for delirium. Its primary objective was to assess the effects of these interventions on the duration of delirium. Its secondary objectives were, first, to assess the effects of these interventions on delirium-free and coma-free days, days with coma, delirium relapse, duration of mechanical ventilation, ICU and hospital length of stay, mortality, and long-term outcomes (such as cognitive, discharge disposition, or health-related quality of life), and second, to assess the safety of the pharmacological interventions.

This review included 14 RCTs with 1,844 participants. Ten RCTs were placebo controlled, while four compared different pharmacological interventions. Drugs included in the comparisons were antipsychotics, α2 agonists, statins, opioids, serotonin antagonists, and cholinesterase inhibitors. Eleven of the RCTs reported on the primary outcome (duration of delirium). While the studies were small, they were found to have a good design, and nine of the 14 had a low risk of bias.

The only drug that reduced the duration of delirium, compared with placebo, was the α2 agonist dexmedetomidine, while the cholinesterase inhibitor rivastigmine prolonged the duration. Each of these results, however, is based on findings from a single small study. When compared with placebo, the other drugs did not show a change in delirium duration.

The effect of the six drug classes on the duration of delirium was also compared using network meta-analysis, which failed to rule out the possibility of no difference between them compared with placebo. None of the drugs was found to improve coma duration, length of stay, long-term cognitive outcomes, or risk of mortality.

BEST PRACTICE RECOMMENDATIONS

This review finds that the α2 agonist dexmedetomidine may shorten the duration of delirium in critically ill adults. The authors found no evidence of a difference between placebo and any other pharmacological intervention, including commonly used antipsychotics, in terms of an effect on delirium duration or any secondary outcomes. One drug, the cholinesterase inhibitor rivastigmine, was associated with a prolonged delirium duration. These findings are significant because antipsychotics—the most commonly used pharmacological intervention for delirium in critically ill adults—were not found to be effective.

Treatment options for critically ill adults experiencing delirium are a high priority for patients, caregivers, and health professionals. Future studies would benefit from standardization of study outcomes, reporting of symptom management, inclusion of long-term outcomes, and use of nonpharmacological treatment options.

SOURCE DOCUMENT
Burry L, et al. Pharmacological interventions for the treatment of delirium in critically ill adults. Cochrane Database Syst Rev 2019;9:CD011749.

Calculate the price
Make an order in advance and get the best price
Pages (550 words)
$0.00
*Price with a welcome 20% discount applied.
Pro tip: If you want to save more money and pay the lowest price, you need to set a more extended deadline.
We know how difficult it is to be a student these days. That's why our prices are one of the most affordable on the market, and there are no hidden fees.

Instead, we offer bonuses, discounts, and free services to make your experience outstanding.
How it works
Receive a 100% original paper that will pass Turnitin from a top essay writing service
step 1
Upload your instructions
Fill out the order form and provide paper details. You can even attach screenshots or add additional instructions later. If something is not clear or missing, the writer will contact you for clarification.
Pro service tips
How to get the most out of your experience with My Course Writer
One writer throughout the entire course
If you like the writer, you can hire them again. Just copy & paste their ID on the order form ("Preferred Writer's ID" field). This way, your vocabulary will be uniform, and the writer will be aware of your needs.
The same paper from different writers
You can order essay or any other work from two different writers to choose the best one or give another version to a friend. This can be done through the add-on "Same paper from another writer."
Copy of sources used by the writer
Our college essay writers work with ScienceDirect and other databases. They can send you articles or materials used in PDF or through screenshots. Just tick the "Copy of sources" field on the order form.
Testimonials
See why 10k+ students have chosen us as their sole writing assistance provider
Check out the latest reviews and opinions submitted by real customers worldwide and make an informed decision.
Sociology
Perfect! Appreciate all of your help! Thank you so much!
Customer 452483, November 14th, 2021
Mathematics
Thank you, great work!
Customer 452483, July 19th, 2021
Group Dynamics
Great job. I appreciate it.
Customer 452521, November 22nd, 2021
Communications
Well done! I thank you very much!
Customer 452483, July 9th, 2021
Education
Great good
Customer 452555, February 14th, 2022
Nursing
Excellent job! super recommended.
Customer 452487, August 24th, 2021
Psychology
Thank you for all of your help and hard work, truly appreciate you guys always being there with my hectic schedule. Thank you again!
Customer 452483, September 20th, 2021
English 101
This writer was very quick with the draft and even faster with the revision! Thank you!
Customer 452603, May 30th, 2022
Microbiology
Appreciate all of your hard work! Thank you so much!!
Customer 452483, September 14th, 2021
Mathematics
PERFECT! Thanks a million, you're all awesome!!!!
Customer 452483, July 7th, 2021
Mathematics
Thank you so much!
Customer 452483, July 26th, 2021
Microbiology
Perfect! Thank you guys for all of your great help! :)
Customer 452483, August 23rd, 2021
1159
Customer reviews in total
96%
Current satisfaction rate
2 pages
Average paper length
47%
Customers referred by a friend
OUR GIFT TO YOU
20% OFF your first order
Use a coupon 20OFF and enjoy expert help with any task at the most affordable price.
Claim my 20% OFF Order in Chat