%0 Journal Article
%T Improving delirium care in the intensive care unit: The design of a pragmatic study
%A Noll L Campbell
%A Babar A Khan
%A Mark Farber
%A Tiffany Campbell
%A Anthony J Perkins
%A Siu L Hui
%A Greg Abernathy
%A John Buckley
%A Regg Sing
%A Jason Tricker
%A Mohammad Zawahiri
%A Malaz A Boustani
%J Trials
%D 2011
%I BioMed Central
%R 10.1186/1745-6215-12-139
%X This is a randomized controlled trial of 428 patients aged 18 and older suffering from delirium and admitted to the ICU of Wishard Memorial Hospital in Indianapolis. Subjects assigned to the intervention group will receive a multicomponent pharmacological management protocol for delirium (PMD) and those assigned to the control group will receive no change in their usual ICU care. The primary outcomes of the trial are (1) delirium severity as measured by the Delirium Rating Scale revised-98 (DRS-R-98) and (2) delirium duration as determined by the Confusion Assessment Method for the ICU (CAM-ICU). The PMD protocol targets the three neurotransmitter systems thought to be compromised in delirious patients: dopamine, acetylcholine, and gamma-aminobutyric acid. The PMD protocol will target the reduction of anticholinergic medications and benzodiazepines, and introduce a low-dose of haloperidol at 0.5-1 mg for 7 days. The protocol will be delivered by a combination of computer (artificial intelligence) and pharmacist (human intelligence) decision support system to increase adherence to the PMD protocol.The proposed study will evaluate the content and the delivery process of a multicomponent pharmacological management program for delirium in the ICU.ClinicalTrials.gov: NCT00842608In 2005, approximately 2.7 million Americans aged 65 and older spent at least one day in the intensive care unit (ICU) costing Medicare an estimated $27.5 billion [1-3]. It is estimated that up to 80% of these older ICU patients had delirium during their hospital stay [4]. Older adults with delirium are more prone to falls, injuries, pressure ulcers, restraints, mortality, institutionalization, and dementia [4-8]. Delirium is considered an acute brain failure that is most often unrecognized among older adults in the ICU [9-14]. These patients may receive potentially harmful medications such as anticholinergics and benzodiazepines that are thought to cause or worsen delirium [15-18].We conducted a
%U http://www.trialsjournal.com/content/12/1/139