Skip to main content
SpringerLink
Log in

Analgesia, Sedation, and Delirium in the ICU

  • Chapter
  • First Online:
Surgical Critical Care Therapy

  • 2122 Accesses

Abstract

Pain, agitation, and delirium in the ICU are common occurrences; and inappropriate management of these conditions is clearly associated with poorer outcomes, including increased length of mechanical ventilation, length of ICU stay, and risk of mortality. Within this chapter we discuss the best practices regarding both assessment and treatment of these conditions as well as the pharmacology of available agents for analgesia, sedation, and delirium management. A comprehensive approach to improving patient care and comfort is also proposed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Chanques G, et al. A prospective study of pain at rest: incidence and characteristics of an unrecognized symptom in surgical and trauma versus medical intensive care unit patients. Anesthesiology. 2007;107(5):858–60.

    Article  PubMed  Google Scholar 

  2. Reardon DP, Anger KE, Szumita PM. Pathophysiology, assessment, and management of pain in critically ill adults. Am J Health Syst Pharm. 2015;72(18):1531–43.

    Article  CAS  PubMed  Google Scholar 

  3. Hedderich R, Ness TJ. Analgesia for trauma and burns. Crit Care Clin. 1999;15(1):167–84.

    Article  CAS  PubMed  Google Scholar 

  4. Beilin B, et al. Effects of anesthesia based on large versus small doses of fentanyl on natural killer cell cytotoxicity in the perioperative period. Anesth Analg. 1996;82(3):492–7.

    CAS  PubMed  Google Scholar 

  5. Peterson PK, et al. Stress and pathogenesis of infectious disease. Rev Infect Dis. 1991;13(4):710–20.

    Article  CAS  PubMed  Google Scholar 

  6. Barr J, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306.

    Article  PubMed  Google Scholar 

  7. Joffe AM, et al. Validation of the critical-care pain observation tool in brain-injured critically ill adults. J Crit Care. 2016;36:76–80.

    Article  PubMed  Google Scholar 

  8. Kanji S, et al. Validation of the critical care pain observation tool in critically ill patients with delirium: a prospective cohort study. Crit Care Med. 2016;44(5):943–7.

    Article  PubMed  Google Scholar 

  9. Payen JF, et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology. 2007;106(4):687–95. quiz 891-2

    Article  PubMed  Google Scholar 

  10. Dale O, et al. Disposition of nasal, intravenous, and oral methadone in healthy volunteers. Clin Pharmacol Ther. 2002;72(5):536–45.

    Article  CAS  PubMed  Google Scholar 

  11. Erstad BL, Chopda S, Esser MJ. Prescribing of analgesics in trauma patients. Am J Ther. 1997;4(1):27–30.

    Article  CAS  PubMed  Google Scholar 

  12. Vital signs: overdoses of prescription opioid pain relievers and other drugs among women--United States, 1999–2010. MMWR Morb Mortal Wkly Rep. 2013;62(26):537–42.

    Google Scholar 

  13. Oyler DR, et al. Nonopioid management of acute pain associated with trauma: focus on pharmacologic options. J Trauma Acute Care Surg. 2015;79(3):475–83.

    Article  PubMed  Google Scholar 

  14. Malchow RJ, Black IH. The evolution of pain management in the critically ill trauma patient: emerging concepts from the global war on terrorism. Crit Care Med. 2008;36(7 Suppl):S346–57.

    Article  PubMed  Google Scholar 

  15. Marquez-Lara A, et al. Nonsteroidal anti-inflammatory drugs and bone-healing: a systematic review of research quality. JBJS Rev. 2016;4(3):1–14

    Article  Google Scholar 

  16. Pountos I, et al. Do nonsteroidal anti-inflammatory drugs affect bone healing? a critical analysis. ScientificWorldJournal. 2012;2012:606404.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Bhangu A, et al. Postoperative nonsteroidal anti-inflammatory drugs and risk of anastomotic leak: meta-analysis of clinical and experimental studies. World J Surg. 2014;38(9):2247–57.

    Article  PubMed  Google Scholar 

  18. Elia N, Lysakowski C, Tramer MR. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? meta-analyses of randomized trials. Anesthesiology. 2005;103(6):1296–304.

    Article  CAS  PubMed  Google Scholar 

  19. Guillou N, et al. The effects of small-dose ketamine on morphine consumption in surgical intensive care unit patients after major abdominal surgery. Anesth Analg. 2003;97(3):843–7.

    Article  CAS  PubMed  Google Scholar 

  20. Roeckel LA, et al. Opioid-induced hyperalgesia: cellular and molecular mechanisms. Neuroscience. 2016;338:160–82.

    Article  CAS  PubMed  Google Scholar 

  21. Wang X, et al. Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials. J Anesth. 2014;28(6):821–7.

    Article  PubMed  Google Scholar 

  22. Elefritz JL, et al. Methadone analgesia in the critically ill. J Crit Care. 2016;34:84–8.

    Article  PubMed  Google Scholar 

  23. Weimer MB, et al. The source of methadone in overdose deaths in Western Virginia in 2004. J Addict Med. 2011;5(3):188–202.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Adams MM, Hicks AL. Spasticity after spinal cord injury. Spinal Cord. 2005;43(10):577–86.

    Article  CAS  PubMed  Google Scholar 

  25. Pandey CK, et al. The comparative evaluation of gabapentin and carbamazepine for pain management in Guillain-Barre syndrome patients in the intensive care unit. Anesth Analg. 2005;101(1):220–5. table of contents

    Article  CAS  PubMed  Google Scholar 

  26. Gordh TE, et al. Gabapentin in traumatic nerve injury pain: a randomized, double-blind, placebo-controlled, cross-over, multi-center study. Pain. 2008;138(2):255–66.

    Article  CAS  PubMed  Google Scholar 

  27. Melemeni A, Staikou C, Fassoulaki A. Gabapentin for acute and chronic post-surgical pain. Signa Vitae. 2007;2:S42–51.

    Article  CAS  Google Scholar 

  28. Vedula SS, et al. Outcome reporting in industry-sponsored trials of gabapentin for off-label use. N Engl J Med. 2009;361(20):1963–71.

    Article  CAS  PubMed  Google Scholar 

  29. Kharasch ED, Eisenach JC. Wherefore Gabapentinoids?: was there rush too soon to judgment? Anesthesiology. 2016;124(1):10–2.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled veterans affairs cooperative study. Ann Surg. 2001;234(4):560–9. discussion 569-71

    Article  CAS  PubMed  Google Scholar 

  31. Guay J, Kopp S. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev. 2016;(1):CD005059.

    Google Scholar 

  32. Simon BJ, et al. Pain management guidelines for blunt thoracic trauma. J Trauma. 2005;59(5):1256–67.

    Article  PubMed  Google Scholar 

  33. Zink KA, et al. Lidocaine patches reduce pain in trauma patients with rib fractures. Am Surg. 2011;77(4):438–42.

    PubMed  Google Scholar 

  34. Karmakar MK, et al. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003;54(3):615–25.

    Article  PubMed  Google Scholar 

  35. Niraj G, et al. Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, non-inferiority trial. Anaesthesia. 2014;69(4):348–55.

    Article  CAS  PubMed  Google Scholar 

  36. Brady RR, et al. Open transversus abdominis plane block and analgesic requirements in patients following right hemicolectomy. Ann R Coll Surg Engl. 2012;94(5):327–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Fraser GL, et al. Frequency, severity, and treatment of agitation in young versus elderly patients in the ICU. Pharmacotherapy. 2000;20(1):75–82.

    Article  CAS  PubMed  Google Scholar 

  38. Strom T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010;375(9713):475–80.

    Article  PubMed  Google Scholar 

  39. Kress JP, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342(20):1471–7.

    Article  CAS  PubMed  Google Scholar 

  40. Mehta S, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA. 2012;308(19):1985–92.

    Article  CAS  PubMed  Google Scholar 

  41. Kollef MH, et al. The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest. 1998;114(2):541–8.

    Article  CAS  PubMed  Google Scholar 

  42. Treggiari MM, et al. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med. 2009;37(9):2527–34.

    Article  PubMed  Google Scholar 

  43. Barnes BJ, et al. Osmol gap as a surrogate marker for serum propylene glycol concentrations in patients receiving lorazepam for sedation. Pharmacotherapy. 2006;26(1):23–33.

    Article  CAS  PubMed  Google Scholar 

  44. Haeseler G, et al. High-affinity blockade of voltage-operated skeletal muscle and neuronal sodium channels by halogenated propofol analogues. Br J Pharmacol. 2008;155(2):265–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Fowler CJ. Possible involvement of the endocannabinoid system in the actions of three clinically used drugs. Trends Pharmacol Sci. 2004;25(2):59–61.

    Article  CAS  PubMed  Google Scholar 

  46. Aitkenhead AR, et al. Comparison of propofol and midazolam for sedation in critically ill patients. Lancet. 1989;2(8665):704–9.

    Article  CAS  PubMed  Google Scholar 

  47. Hall RI, et al. Propofol vs midazolam for ICU sedation : a Canadian multicenter randomized trial. Chest. 2001;119(4):1151–9.

    Article  CAS  PubMed  Google Scholar 

  48. Carson SS, et al. A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients. Crit Care Med. 2006;34(5):1326–32.

    Article  CAS  PubMed  Google Scholar 

  49. Jakob SM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012;307(11):1151–60.

    Article  CAS  PubMed  Google Scholar 

  50. Muellejans B, et al. Sedation in the intensive care unit with remifentanil/propofol versus midazolam/fentanyl: a randomised, open-label, pharmacoeconomic trial. Crit Care. 2006;10(3):R91.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Devlin JW, Lau AK, Tanios MA. Propofol-associated hypertriglyceridemia and pancreatitis in the intensive care unit: an analysis of frequency and risk factors. Pharmacotherapy. 2005;25(10):1348–52.

    Article  CAS  PubMed  Google Scholar 

  52. Lee HM, et al. What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient? Clin Toxicol (Phila). 2015;53(3):145–50.

    Article  CAS  Google Scholar 

  53. Mirrakhimov AE, et al. Propofol infusion syndrome in adults: a clinical update. Crit Care Res Pract. 2015;2015:260385.

    PubMed  PubMed Central  Google Scholar 

  54. Mayette M, et al. Propofol infusion syndrome resuscitation with extracorporeal life support: a case report and review of the literature. Ann Intensive Care. 2013;3(1):32.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Walli A, et al. Propofol infusion syndrome in refractory status epilepticus: a case report and topical review. Case Rep Emerg Med. 2016;2016:3265929.

    PubMed  PubMed Central  Google Scholar 

  56. Chen K, et al. Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients. Cochrane Database Syst Rev. 2015;(1):Cd010269.

    Google Scholar 

  57. Riker RR, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301(5):489–99.

    Article  CAS  PubMed  Google Scholar 

  58. Farasatinasab M, et al. A randomized placebo-controlled trial of clonidine impact on sedation of mechanically ventilated ICU patients. Iran J Pharm Res. 2015;14(1):167–75.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Gagnon DJ, et al. Transition from dexmedetomidine to enteral clonidine for ICU sedation: an observational pilot study. Pharmacotherapy. 2015;35(3):251–9.

    Article  CAS  PubMed  Google Scholar 

  60. Mion G, Villevieille T. Ketamine pharmacology: an update (pharmacodynamics and molecular aspects, recent findings). CNS Neurosci Ther. 2013;19(6):370–80.

    Article  CAS  PubMed  Google Scholar 

  61. Benken ST, Goncharenko A. The future of intensive care unit sedation: a report of continuous infusion ketamine as an alternative sedative agent. J Pharm Pract. 2017;30(5):576–581. doi: 10.1177/0897190016646293. Epub 2016 May 2.

    Article  PubMed  Google Scholar 

  62. Umunna BP, et al. Ketamine for continuous sedation of mechanically ventilated patients. J Emerg Trauma Shock. 2015;8(1):11–5.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Pisani MA, et al. A research algorithm to improve detection of delirium in the intensive care unit. Crit Care. 2006;10(4):R121.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Pandharipande P, et al. Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med. 2007;33(10):1726–31.

    Article  PubMed  Google Scholar 

  65. Skrobik Y. Delirium prevention and treatment. Crit Care Clin. 2009;25(3):585–91.

    Article  CAS  PubMed  Google Scholar 

  66. Joyce C, et al. Evaluation of the safety of quetiapine in treating delirium in critically ill children: a retrospective review. J Child Adolesc Psychopharmacol. 2015;25(9):666–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Shehabi Y, et al. Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Crit Care Med. 2010;38(12):2311–8.

    Article  PubMed  Google Scholar 

  68. Ely EW, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753–62.

    Article  CAS  PubMed  Google Scholar 

  69. Salluh JI, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015;350:h2538.

    Article  PubMed  PubMed Central  Google Scholar 

  70. LL RJL. The nature and extent of medical injury in older patients. In: The public policy institute. Washington, DC: AARP; 2000.

    Google Scholar 

  71. Milbrandt EB, et al. Costs associated with delirium in mechanically ventilated patients. Crit Care Med. 2004;32(4):955–62.

    Article  PubMed  Google Scholar 

  72. Smith CD, Grami P. Feasibility and effectiveness of a delirium prevention bundle in critically ill patients. Am J Crit Care. 2016;26(1):19–27.

    Article  PubMed  Google Scholar 

  73. Huai J, Ye X. A meta-analysis of critically ill patients reveals several potential risk factors for delirium. Gen Hosp Psychiatry. 2014;36(5):488–96.

    Article  PubMed  Google Scholar 

  74. Brummel NE, et al. Implementing delirium screening in the ICU: secrets to success. Crit Care Med. 2013;41(9):2196–208.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Ely EW, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370–9.

    Article  CAS  PubMed  Google Scholar 

  76. Gusmao-Flores D, et al. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care. 2012;16(4):R115.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Haenggi M, et al. Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC. Intensive Care Med. 2013;39(12):2171–9.

    Article  CAS  PubMed  Google Scholar 

  78. Patel SB, et al. Rapidly reversible, sedation-related delirium versus persistent delirium in the intensive care unit. Am J Respir Crit Care Med. 2014;189(6):658–65.

    Article  PubMed  Google Scholar 

  79. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.

    Article  PubMed  Google Scholar 

  80. Truman B, Ely EW. Monitoring delirium in critically ill patients. Using the confusion assessment method for the intensive care unit. Crit Care Nurse. 2003;23(2):25–36. quiz 37-8

    PubMed  Google Scholar 

  81. Otremba I, Wilczynski K, Szewieczek J. Delirium in the geriatric unit: proton-pump inhibitors and other risk factors. Clin Interv Aging. 2016;11:397–405.

    CAS  PubMed  PubMed Central  Google Scholar 

  82. Smonig R, et al. Constipation is independently associated with delirium in critically ill ventilated patients. Intensive Care Med. 2016;42(1):126–7.

    Article  PubMed  Google Scholar 

  83. Flannery AH, Oyler DR, Weinhouse GL. The impact of interventions to improve sleep on delirium in the ICU: a systematic review and research framework. Crit Care Med. 2016;44(12):2231–40.

    Article  PubMed  Google Scholar 

  84. Siew ED, et al.. Acute kidney injury as a risk factor for delirium and coma during critical illness. Am J Respir Crit Care Med. 2017;195(12):1597–1607.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Crit Care Clin. 2013;29(1):51–65.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Pandharipande P, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006;104(1):21–6.

    Article  CAS  PubMed  Google Scholar 

  87. Zaal IJ, et al. Benzodiazepine-associated delirium in critically ill adults. Intensive Care Med. 2015;41(12):2130–7.

    Article  CAS  PubMed  Google Scholar 

  88. Weinhouse GL, Schwab RJ. Sleep in the critically ill patient. Sleep. 2006;29(5):707–16.

    Article  PubMed  Google Scholar 

  89. Girard TD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomised controlled trial. Lancet. 2008;371(9607):126–34.

    Article  PubMed  Google Scholar 

  90. Mehta S, et al. Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med. 2015;43(3):557–66.

    Article  PubMed  Google Scholar 

  91. Wolters AE, et al. Systemic corticosteroids and transition to delirium in critically ill patients. Crit Care Med. 2015;43(12):e585–8.

    Article  CAS  PubMed  Google Scholar 

  92. Schreiber MP, et al. Corticosteroids and transition to delirium in patients with acute lung injury. Crit Care Med. 2014;42(6):1480–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  93. Morandi A, et al. Statins and delirium during critical illness: a multicenter, prospective cohort study. Crit Care Med. 2014;42(8):1899–909.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Nelson S, et al. Defining the role of Dexmedetomidine in the prevention of delirium in the intensive care unit. Biomed Res Int. 2015;2015:635737.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Rivosecchi RM, et al. Nonpharmacological interventions to prevent delirium: an evidence-based systematic review. Crit Care Nurse. 2015;35(1):39–50. quiz 51

    Article  PubMed  Google Scholar 

  96. Barnes-Daly MA, Phillips G, Ely EW. Improving hospital survival and reducing brain dysfunction at seven California community hospitals: implementing PAD guidelines via the ABCDEF bundle in 6,064 patients. Crit Care Med. 2017;45(2):171–8.

    Article  PubMed  Google Scholar 

  97. Maldonado JR. Delirium in the acute care setting: characteristics, diagnosis and treatment. Crit Care Clin. 2008;24(4):657–722. vii

    Article  CAS  PubMed  Google Scholar 

  98. Litton E, et al. The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: a systematic review and meta-analysis. Crit Care Med. 2016;44(5):992–9.

    Article  PubMed  Google Scholar 

  99. Wassenaar A, et al. The impact of nUrsiNg DEliRium preventive INnterventions in the intensive care unit (UNDERPIN-ICU): a study protocol for a multi-centre, stepped wedge randomized controlled trial. Int J Nurs Stud. 2016;68:1–8.

    Article  PubMed  Google Scholar 

  100. Siddiqi N, et al. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2016;(3):Cd005563.

    Google Scholar 

  101. Larsen KA, et al. Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics. 2010;51(5):409–18.

    Article  CAS  PubMed  Google Scholar 

  102. Prakanrattana U, Prapaitrakool S. Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care. 2007;35(5):714–9.

    CAS  PubMed  Google Scholar 

  103. Su X, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10054):1893–902.

    Article  CAS  PubMed  Google Scholar 

  104. Mekontso Dessap A, et al. Delirium and circadian rhythm of melatonin during weaning from mechanical ventilation: an ancillary study of a weaning trial. Chest. 2015;148(5):1231–41.

    Article  Google Scholar 

  105. Huang HW, et al. Effect of oral melatonin and wearing earplugs and eye masks on nocturnal sleep in healthy subjects in a simulated intensive care unit environment: which might be a more promising strategy for ICU sleep deprivation? Crit Care. 2015;19:124.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  106. Hatta K, et al. Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA Psychiat. 2014;71(4):397–403.

    Article  CAS  Google Scholar 

  107. Walker CK, Gales MA. Melatonin receptor agonists for delirium prevention. Ann Pharmacother. 2017;51(1):72–78. doi: 10.1177/1060028016665863. Epub 2016 Aug 20.

    Article  CAS  PubMed  Google Scholar 

  108. Girard TD, et al. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med. 2010;38(2):428–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Page VJ, et al. Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (hope-ICU): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2013;1(7):515–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  110. Skrobik YK, et al. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med. 2004;30(3):444–9.

    Article  PubMed  Google Scholar 

  111. Devlin JW, et al. Quetiapine for intensive care unit delirium: the evidence remains weak. Pharmacotherapy. 2016;36(2):e12-3. discussion e13-4

    Article  Google Scholar 

  112. Devlin JW, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med. 2010;38(2):419–27.

    Article  CAS  PubMed  Google Scholar 

  113. Michaud CJ, et al. Impact of quetiapine treatment on duration of hypoactive delirium in critically ill adults: a retrospective analysis. Pharmacotherapy. 2015;35(8):731–9.

    Article  CAS  PubMed  Google Scholar 

  114. Swan JT, et al. Antipsychotic use and diagnosis of delirium in the intensive care unit. Crit Care. 2012;16(3):R84.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Flurie RW, et al. Hospital delirium treatment: continuation of antipsychotic therapy from the intensive care unit to discharge. Am J Health Syst Pharm. 2015;72(23 Suppl 3):S133–9.

    Article  PubMed  Google Scholar 

  116. Tomichek JE, et al. Antipsychotic prescribing patterns during and after critical illness: a prospective cohort study. Crit Care. 2016;20(1):378.

    Article  PubMed  PubMed Central  Google Scholar 

  117. Gagnon DJ, et al. Valproate for agitation in critically ill patients: a retrospective study. J Crit Care. 2017;37:119–25.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

All authors report no conflicts of interest, including pharmaceutical or industry support, regarding any of the information contained in this report. No relevant funding from any organization was provided to any of the authors regarding this manuscript or the ideas contained herein.

Author information

Authors and Affiliations

  1. Department of Pharmacy, University of Kentucky Chandler Medical Center, Lexington, KY, USA

    Douglas R. Oyler

  2. Department of Surgery, University of Kentucky, Lexington, KY, USA

    Andrew C. Bernard

Authors
  1. Douglas R. Oyler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew C. Bernard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew C. Bernard .

Editor information

Editors and Affiliations

  1. Brigham and Womens’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Ali Salim

  2. Dell Medical School, University of Texas at Austin, Austin, Texas, USA

    Carlos Brown

  3. Division of Trauma Surgery, Rm C5L100, University of Southern California, Los Angeles, California, USA

    Kenji Inaba

  4. Trauma and Emergency Surgery Service, Legacy Emanuel Medical Center, Portland, Oregon, USA

    Matthew J. Martin

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Oyler, D.R., Bernard, A.C. (2018). Analgesia, Sedation, and Delirium in the ICU. In: Salim, A., Brown, C., Inaba, K., Martin, M. (eds) Surgical Critical Care Therapy . Springer, Cham. https://doi.org/10.1007/978-3-319-71712-8_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-71712-8_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71711-1

  • Online ISBN: 978-3-319-71712-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation