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Coma, Confusion, and Agitation in Intensive Care

  • Matthew Clark
  • Justin McKinlay
Chapter
Part of the Competency-Based Critical Care book series (CBCC)

Key Points

  1. 1.

    Coma and delirium are very common in critically ill patients, and represent an independent risk factor for poor outcome.

     
  2. 2.

    Management of the comatose patient involves rapid initial assessment and correction of easily reversible causes, protecting the brain from further injury, diagnosing and specifically treating the underlying cause, plus good generic multidisciplinary care.

     
  3. 3.

    Management of delirium includes rapid assessment, treatment of easily reversible causes (pain, urinary retention, hypoxia, hypotension etc.) and investigation of other causes. Nonpharmacological measures are as important as drug therapy.

     
  4. 4.

    Guidelines (and adherence to them) are useful for both the assessment of delirium and monitoring of sedation scores.

     
  5. 5.

    The ideal sedative agent does not exist. Choice of agent(s) should be patient-specific, monitored closely to achieve the desired end-point with the minimum of side effects and given for the shortest time necessary.

     
  6. 6.

    Inappropriate use of sedatives may actually worsen or prolong delirium.

     

Keywords

Glasgow Coma Scale Alcohol Withdrawal Malignant Hyperthermia Comatose Patient Sixth Cranial Nerve Palsy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

Journal Articles

  1. Cohen IL, Gallagher TJ, Pohlman AS et al (2002) Management of the agitated intensive care unit patient. Crit Care Med 30:S97–S123CrossRefGoogle Scholar
  2. Ely EW, Shintani A, Truman B et al (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753–1762CrossRefPubMedGoogle Scholar
  3. Jacobi J, Fraser GL, Coursin DB et al (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–141CrossRefPubMedGoogle Scholar
  4. Kress JP, Pohlman AS, Hall JB (2002) Sedation and analgesia in the intensive care unit. Am J Respir Crit Care Med 166(8):1024–1028CrossRefPubMedGoogle Scholar
  5. Mayer SA, Chong JY, Ridgway E et al (2001) Delirium from nicotine withdrawal in neuro-ICU patients. Neurology 57:551–553PubMedGoogle Scholar
  6. Osterman ME, Keenan SP, Seiferling RA et al (2000) Sedation in the intensive care unit: a systematic review. JAMA 283:1451–1459CrossRefGoogle Scholar
  7. Pandharipande P, Jackson J, Ely EW (2005) Delirium: acute cognitive dysfunction in the critically ill. Curr Opin Crit Care 11:360–368PubMedGoogle Scholar

Books

  1. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. (1994) American Psychiatric AssociationGoogle Scholar
  2. Fink M, Abraham E, Vincent J-L, Kochanek P (2005) Textbook of Critical Care 5th edn. Saunders WB, OxfordGoogle Scholar
  3. Oh TE, Bersten AD, Soni N (eds) (2003) Intensive care manual, 5th edn. Butterworth-Heinemann, Phila-delphiaGoogle Scholar
  4. Webb AJ, Shapiro MJ, Singer M, Suter P (eds) (1999) Oxford textbook of critical care. Oxford University Press, OxfordGoogle Scholar
  5. Yentis SM, Hirsch NP, Smith GB (2004) Anaesthesia and intensive care A-Z. Butterworth-Heinemann, OxfordGoogle Scholar

Other Publications

  1. An Acute Problem? National Confidential Enquiry into Patient Outcome and Death. London. 2005. www.ncepod.org.uk

Copyright information

© Springer-Verlag London Limited 2010

Authors and Affiliations

  • Matthew Clark
    • 1
  • Justin McKinlay
    • 2
  1. 1.Department of Anesthetics and Intensive CareLeeds General Infirmary Leeds Teaching Hospitals NHS TrustLeedsUK
  2. 2.Department of Anaesthetics and Neurocritical CareLeeds General Infirmary, Leeds Teaching Hospitals NHS TrustLeedsUK

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