Checklist for Treatment of Delirium in the ICU Remove causative factors - Exclude hypoglycemia if this is possible - Review the medication list and d/c deliriogenic meds if possible. - Treat hypernatremia if present. - Remove unnecessary invasive devices/tubes & restraints. - Consider scheduled acetaminophen if uncontrolled pain or persistent fevers. - If Wernicke's encephalopathy possible, empiric thiamine 500 mg IV Q8hr - If cirrhotic, consider empiric treatment for hepatic encephalopathy Sleep maintenance - Scheduled melatonin agonist before sleep (melatonin -•3 mg or ramelteon 8 mg). - Earplugs & eye shades at night if tolerated. - Avoid unnecessary sleep interruption (e.g. frequent Bp cuff monitoring). - If difficulty sleeping, administer pharmacologic therapy early in the night (e.g. quetiapine 50 mg qhs) Nocturnal dexmedetomidine - May be useful in patients with severe nocturnal agitation, especially if this is refractory to antipsychotic therapy. - Use dexmedetomidine at night, titrate to light sleep. - Discontinue dexmedetomidine during the day to maintain circadian rhythm. Reorientation during the day - Use patient's glasses & hearing aides if needed - Physical therapy and early mobilization. #Delirium #Checklist #Management #Treatment #MICU #CriticalCare
