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Highlights from recent publications by ADS members and collaborators

Clinical Practice Guideline for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit.

The article describes best practices for the identification, prevention, and treatment of delirium in the ICU. Recommendations include pharmacologic and non-pharmacologic strategies, including evidence-based recommendations for the use of antipsychotics as well as mobilization and sedation practices.

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Haloperidol prophylaxis in critically ill patients with a high risk for delirium.

Following results of reduced delirium incidence following a haloperidol infusion among a surgical population, a recent publication in Critical Care described a prophylactic haloperidol regimen in critically ill adults at high risk of developing delirium (PRE-DELIRIC score at least 50%). Results suggested lower delirium incidence, lower mortality, and more delirium-free days. Although not a randomized controlled design, these results support the further study of the impact of haloperidol prophylaxis on delirium outcomes.

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Pursuing the impact of non-pharmacologic interventions on delirium incidence, Canadian researchers evaluated two different environmental strategies for ICU patient rooms. Neither layout had an impact on delirium prevalence, however a layout that increased exposure to outside lighting reduced the number of days of delirium between the two groups, adding support to the role of non-pharmacologic approaches to reduce the burden of delirium.

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Further work optimizing screening tools for various care environments was published in BMC Medical Research Methodology. The authors present a bank of items for use in the development of screening tools that are selected for their psychometric properties and accuracy in determining the four core features of delirium. This work represents a necessary step in the development of brief, efficient delirium screening tools.

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