Prophylactic Use of Haloperidol versus Atypical Antipsychotics (Quetiapine) in Prophylaxis against ICU Delirium in High Risk Patients

Abstract

elirium is defined as a disturbance of consciousness and cognition that develops over a short period of time (hours to days) and fluctuates over time. The prevalence of delirium reported in medical and surgical ICU has varied from 20% to 80%, depending upon severity of illness observed and diagnostic methods used. Delirium can be categorized into subtypes according to psychomotor behavior into Hypoactive, hyperactive and mixed. The patho-physiology of delirium related to neurotransmitter imbalance (an excess of dopamine or depletion of), Inflammation and Impaired oxidative metabolism. Risk factors for delirium: Host factor (Elderly, smoking, alcoholism) underlying co-morbidities, Acute illness, Iatrogenic, inappropriate use of Sedative and analgesic medications and Sleep disturbances. After exclusion of other medical cause of confusional state; Diagnosis of delirium in ICU depends in clinical manifestation and using specific tool for assessment by two step approach to sedation and delirium, the first step in neurological assessment is to assess the patient's level of consciousness or sedation with an objective sedation assessment using one of Ramsay scale, sedation –agitation scale or Richmond agitation sedation scale.