Benzodiazepine-associated delirium in critically ill adults

Zaal, Irene J.; Devlin, John W.; Hazelbag, Marijn; Klouwenberg, Peter M. C. Klein; Kooi, Arendina W. van der; Ong, David S. Y.; Cremer, Olaf L.; Groenwold, Rolf H.H.; Slooter, Arjen J. C.

doi:10.1007/s00134-015-4063-z

Cited by 196 publications

(143 citation statements)

References 44 publications

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“…While never studied formally in patients with cardiac disease, these medications have been associated with a reduced risk of HF hospitalization and cardiac mortality in patients with a history of MI [118], suggesting potential benefit in these patient groups. Benzodiazepines can cause respiratory depression, so they likely should be used cautiously in patients with acute HF exacerbations, and they have been linked to falls in the elderly and confusion [119-121]. Finally, there is the risk of abuse or dependence in patients with substance use disorders.…”

Section: Management Of Anxiety Disordersmentioning

confidence: 99%

Anxiety Disorders and Cardiovascular Disease

Celano

Daunis

Lokko

et al. 2016

Curr Psychiatry Rep

276

173

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Anxiety and its associated disorders are common in patients with cardiovascular disease and may significantly influence cardiac health. Anxiety disorders are associated with the onset and progression of cardiac disease, and in many instances have been linked to adverse cardiovascular outcomes, including mortality. Both physiologic (autonomic dysfunction, inflammation, endothelial dysfunction, changes in platelet aggregation) and health behavior mechanisms may help to explain the relationships between anxiety disorders and cardiovascular disease. Given the associations between anxiety disorders and poor cardiac health, the timely and accurate identification and treatment of these conditions is of the utmost importance. Fortunately, pharmacologic and psychotherapeutic interventions for the management of anxiety disorders are generally safe and effective. Further study is needed to determine whether interventions to treat anxiety disorders ultimately impact both psychiatric and cardiovascular health.

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Section: Management Of Anxiety Disordersmentioning

confidence: 99%

Anxiety Disorders and Cardiovascular Disease

Celano

Daunis

Lokko

et al. 2016

Curr Psychiatry Rep

276

173

View full text Add to dashboard Cite

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“…Finally, we collected little data about patients who did not develop delirium in the ICCU. As mentioned, we chose not to assess data regarding particular sedation agents used or doses and to focus instead on age-and gender-related differences, although in other studies [7,9,22,24,25] the significance of medication on development of delirium has been addressed. We are further investigating this subject and hope to publish our findings in the near future.…”

Section: Limitations Of the Studymentioning

confidence: 99%

Age- and gender-related peculiarities of patients with delirium in the cardiac intensive care unit

Šerpytis

Navickas

et al. 2017

Kardiol Pol

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A b s t r a c t Background:The overall evidence base regarding delirium has been growing steadily over the past few decades. There has been considerable analysis of delirium concerning, for example, mechanically ventilated patients, patients in the general intensive care unit (ICU) setting, and patients with exclusively postoperative delirium. Nevertheless, there are few studies regarding delirium in a cardiovascular ICU (ICCU) setting and especially scarce literature about the particular features of delirium relating to patient age and gender. Aim:We aimed to determine particular features of delirium not induced by alcohol or other psychoactive substances, relating to patient age and gender in an ICCU setting.Methods: An observational cross-sectional study was conducted to evaluate patients with delirium in a Lithuanian ICCU. From a sample of 19,007 ICCU admissions, 337 (1.8%) had documented delirium diagnosed through liaison and consultation with a psychiatrist and were included in the final analysis. The obtained data was then evaluated and analysed according to patients' gender and four categorised age groups: < 65 years, 65-74 years, 75-84 years, and ≥ 85 years. Results:Female patients who experienced delirium demonstrated a higher prevalence of hypertension, hyponatraemia, heart failure, cardiac rhythm and conduction disorders, myocardial infarction (MI), and dementia. The men, who were on average seven years younger than the women, significantly more often had hypokalaemia, double-or triple-vessel coronary artery disease, and sepsis. Furthermore, MI, ST-segment elevated MI, and Killip class 4 were most frequent amongst patients less than 65 years of age. Moreover, the youngest patient group demonstrated the highest mortality. Conclusions:Our investigation presented a number of associated peculiarities related to gender and age. It was shown that delirium is a severe complication that more often affects men amongst patients < 65 years old and more frequently affects women in the age group of ≥ 85 years. Male patients < 65 years old, who develop delirium should be treated with more caution because they tend to have more serious forms of disorder and a poorer prognosis.

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“…In a cohort study in 1112 critically ill adults, benzodiazepine administration was associated with an increased risk of transition from an awake, clear-conscious state to delirium on the following day, and continuous infusion of the drug was associated with a higher risk of transition compared to intermittent bolus [12]. Such findings strengthen the argument for reliance on non-benzodiazepine sedative agents in critically ill patients.…”

Section: Fig 1 Risk Factors and Contributors To Critical Illness-acqmentioning

confidence: 66%

Critical illness: the brain is always in the line of fire

Smith

Meyfroidt

2017

Intensive Care Med

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Life-threatening systemic insults or diseases often affect the brain. In critically ill patients, acute brain dysfunction manifests in several ways including reduced consciousness, coma, or delirium. The pathophysiology is complex, incompletely understood, and may relate to critical illness-related inflammatory changes, neurotransmitter imbalances, or failure of adequate energy substrate delivery [1], as well as to the applied treatments, pharmacological neurotoxicity, or the hostile ICU environment (Fig. 1) [2].Delirium warrants some emphasis because it is the most common manifestation of critical illness-related brain dysfunction [3]. In a recent study of 420 critically ill mechanically ventilated adult patients, 54% experienced delirium for at least 1 day (median delirium duration 2 days, interquartile range 1-4 days) [4]. The hippocampus and frontal cortex, both areas that are extremely vulnerable to metabolic and hypoxic-ischemic insults, appear to be predominantly involved. Triggers of ICU delirium include predisposing factors (older age, previous cognitive impairment, arterial hypertension), precipitating factors (mainly related to the severity of critical illness), and factors that can potentially be treated or avoided including medications (benzodiazepines, opioids, and anticholinergics), pain, sepsis, fever, metabolic disturbances (dysglycemia, dysnatremia), and environmental factors (sleep deprivation, noisy environment).An acute encephalopathy is reported in up to 70% of patients with sepsis. Systemic insults, such as hemodynamic changes leading to impaired cerebral perfusion, severe hypoxemia, endocrine dysfunction, or fever, are aggravated by blood-brain barrier dysfunction, impairment of the cerebral microcirculation, microglial activation by pro-and anti-inflammatory cytokines and chemokines, and altered neurotransmission [5]. In some cases this can lead to cerebral edema, ischemia, or seizures.The electroencephalography (EEG) findings of sepsisrelated encephalopathy are characterized by a diffuse cortical dysfunction with generalized EEG slowing and the presence of theta and delta waves [3]. Seizures in sepsis are often non-convulsive in nature and require EEG monitoring for their identification. A recent single-center study identified a high incidence of non-convulsive seizures (11%) and periodic discharges (25%) in a cohort of patients with sepsis-related alterations in mental status, although this was not associated with a higher mortality or disability rates at 6 and 12 months after discharge [6]. However, loss of EEG reactivity to external stimulation, a sign of severe encephalopathy, was associated with increased mortality in this patient cohort. Large, prospective studies are required to determine the outcome effects of EEG abnormalities in the critically ill septic patient and whether their treatment modulates outcomes.Critical illness-related brain dysfunction is associated with worse short-term outcomes, such as longer duration of mechanical ventilation and increased ICU and hospital l...

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Benzodiazepine-associated delirium in critically ill adults

Abstract: After addressing potential methodological limitations of prior studies, we confirm that benzodiazepine administration increases the risk for delirium in critically ill adults but this association seems to be limited to continuous infusion use only.

Cited by 196 publications

References 44 publications

Anxiety Disorders and Cardiovascular Disease

Anxiety Disorders and Cardiovascular Disease

Age- and gender-related peculiarities of patients with delirium in the cardiac intensive care unit

Critical illness: the brain is always in the line of fire

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