Critical Care Scenarios Lightning rounds 37: Weaning the deliriosedated patient (SCCM roundup)
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Feb 14, 2024 Experts in critical care and patient sedation discuss strategies for rescuing deliriosedated patients at SCCM’s Critical Care Congress. Topics include weaning off sedation, patient positioning, pharmacological management, involving family members, and addressing underlying causes of confusion to aid in patient recovery.
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Physical Orientation to Reduce Delirium
- Keep the patient at a RASS score of around -1 to prevent excessive sedation.
- Sit the patient on the side of the bed with their feet touching the floor to reorient the brain and reduce delirium.
Optimize Medication Based on Patient Status
- Evaluate kidney and liver function changes that might worsen delirium or affect medication choice.
- Consider patient history like alcohol use to optimize pharmacologic management for sedation and delirium.
Assess and Address Delirium Causes
- Assess agitation causes like delirium using tools such as CAM-ICU.
- Use pain control without excessive opioids, engage families for reorientation, and promote early mobility to reduce delirium.