Inappropriate Pharmacologic Management Following Positive CAM-ICU Screening in Critically Ill Adults
Keywords:
delirium, benzodiazepines, critical careAbstract
Background: Delirium is a common problem in critically ill patients, contributing to worse outcomes and increased lengths of stay. Although guidelines recommend prioritizing prevention and nonpharmacologic management, medications are often required to maintain patient and staff safety. However, the validated screening tools available make it difficult for physicians and nurses to distinguish between delirium and other types of agitation, leading to varying practice patterns.
Objectives: The primary objective of this study was to describe the use of medications to manage delirium in the medical intensive care unit (MICU) among critically ill patients with delirium, as well as characterize patient and environmental factors that may contribute to inappropriate medication use.
Methods: This was a retrospective study using chart review of adult patients admitted to the MICU of an academic tertiary care center. Descriptive statistics were used to summarize patient characteristics and medication administration events.
Results: Of the 431 patients who met inclusion criteria, 29 received medication administrations within one hour following the index positive CAM-ICU score. Patient and environmental factors were similar between patients receiving appropriate versus inappropriate medications with respect to demographics, history of substance use disorder or dementia, and the time and day of the week of the index positive CAM-ICU score. Patients receiving inappropriate medications were younger on average than those receiving appropriate medications (mean age 61.1 versus 68.8 years). Potentially inappropriate medication administration was uncommon occurring in only 8 (1.9%) patients. The most common medications used in both the appropriate and inappropriate contexts were opioids.
Conclusion: Potentially inappropriate medication administration following positive CAM-ICU screening was uncommon in this cohort. Among patients who received pharmacologic treatment, opioids accounted for most medication administration events, highlighting the challenges of distinguishing pain-related from delirium-related agitation in critically ill patients.
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