Page 484 - Clinical Application of Mechanical Ventilation

450 Chapter 13

TABLE 13-21 Potential Procedures to Reverse Delirium

Withdrawal of Medications Improvement of Clinical Conditions

Alcohol Fever

Analgesics Head injury
Anticholinergics Hepatic failure

Anticonvulsants Hyperparathyroidism and
hypoparathyroidism
Antihistamines
Antihypertensives Hyperthyroidism and hypothyroidism

Antiparkinsonian agents Renal failure
Cardiac drugs

Corticosteroids
Psychiatric agents

© Cengage Learning 2014

defined as a reversible global impairment of cognitive processes manifested chiefly by
Haloperidol (Haldol) disorientation, impaired short-term memory, arousal, attention, illusions, and halluci-
may be effective in sedating
patients who have concurrent nations (McCartney et al., 1993). The initial approach to a ventilator patient present-
agitation and delirium caused ing with delirium should be a search for reversible causes. See Table 13-21 for potential
by use of sedatives.
procedures to reverse delirium.
Nonpharmacologic approaches such as repeated reorientation and explanation
(explain treatment plans to the patient) minimize environmental stress and enhance
communication (written or hand signals in intubated patients may also be helpful).
Drug therapy should be added to nonpharmacologic approaches if the latter are
ineffective and a reversible cause is not found.

Indications. Haloperidol is primarily used in the critically ill, mechanically venti-
lated patient for the control of delirium. The intravenous route of administration is
preferred in the intensive care setting, although the drug may be given intramus-
cularly or orally.

Mechanism of Action. An increase in dopamine release and metabolism have been
postulated as one of the central nervous system derangements manifesting as de-
lirium. Haloperidol blocks dopamine receptors in the central nervous system (lim-
bic, basal ganglia, and brain stem), producing a calming effect (McEvoy, 1995). In
addition, haloperidol blocks dopamine receptors in the chemoreceptor trigger zone
that may be responsible for its antiemetic activity.
antiemetic: Preventing nausea
and vomiting. Adverse Effects. Blockade of dopamine receptors in the central nervous system may
interfere with normal motor function. These adverse effects are called extrapyramidal

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.