[ME2] Meet the Experts2
Non-pharmacological management of delirium in the ICU: Understanding the latest evidence

[ME2] Non-pharmacological management of delirium in the ICU: Understanding the latest evidence

Dale M. Needham (Johns Hopkins University, USA)

【 同時通訳付き】【 ARS（視聴者参加型アンケートシステム）使用】

Dr. Needham is Professor of Pulmonary and Critical Care Medicine, and of Physical Medicine and Rehabilitation at the Johns Hopkins University in Baltimore, USA. He is Director of the “Outcomes After Critical Illness and Surgery” (OACIS) Research Group and core faculty with the Armstrong Institute for Patient Safety and Quality, both at Johns Hopkins. From a clinical perspective, he is an attending physician in the medical intensive care unit at Johns Hopkins Hospital and Medical Director of the Johns Hopkins Critical Care Physical Medicine and Rehabilitation program.

Dr. Needham received his MD degree from McMaster University in Hamilton, Canada, and completed both his residency in internal medicine and his fellowship in critical care medicine at the University of Toronto. He obtained his PhD in Clinical Investigation from the Bloomberg School of Public Health at Johns Hopkins University. Notably, prior to his medical training, he completed Bachelor and Master degrees in Accounting and practiced in a large international accounting firm, with a focus in the health care field.

Dr. Needham is Principal Investigator on a number of NIH research grants and has authored more than 350 publications. His research interests include evaluating and improving ICU patients’ long-term physical, cognitive and mental health outcomes, including research in the areas of sedation, delirium, early physical rehabilitation, and knowledge translation and quality improvement.

Delirium is common in critically ill patients and associated with long-lasting effects after hospital discharge.

Multiple pharmacological strategies have been suggested for the management of delirium in the ICU, but without consistent evidence of benefit. The 2018 Society of Critical Care Medicine (SCCM) clinical practice guidelines on Pain, Agitation/Sedation, Delirium, Immobility and Sleep disruption (PADIS) suggest not routinely using pharmacological interventions for the prevention or treatment of delirium.

However, based on the results of multiple recent studies, the 2018 SCCM PADIS guidelines suggest multi-component, non-pharmacological interventions for the management of delirium in the ICU. Such interventions focus on reducing modifiable risk factors for delirium, including providing cognitive stimulation, optimizing sleep, promoting mobility, and reducing hearing, and vision impairments. Moreover, the ABCDEF bundle, including family engagement, may reduce delirium in the ICU.

This presentation will focus on the latest recommendations and evidence regarding multi-component, non-pharmacological strategies for the management of delirium in critically ill patients.

Free access to the full-text version of four publications related to the 2018 SCCM PADIS guidelines and information about the ABCDEF bundle is available at these web pages:
http://www.sccm.org/ICULiberation/Guidelines
http://www.sccm.org/ICULiberation/ABCDEF-Bundles