Waardenberg, H.C. van (2015) Delirium op de intensive care: de effectiviteit van clonidine en dexmedetomidine bij een haloperidol-resistent delirium. thesis, Medicine.
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Abstract
Context: 1 out of 3 intensive care patients develops a delirium. These patients have a longer ICU/hosptial-stay, have a worse outcome and have an increased chance of cognitive impairment. For these reasons, it is important that these patients receive sufficient treatment. Worldwide, the first choice of treatment is haloperidol. If this is not sufficient enough, other pharmaceutical interventions can be considered, for example 2-agonists. In clinical practice, clonidine and dexmedetomidine are given randomly and the choice which of the 2-agonist will be given is based on expert opinions. In this study we compared the effect of these 2-agonists on patients who develop a haloperidol-resistent delirium. Method: This pilot study randomized patients either into the clonidine group or into the dexmedetomidine group when treatment with haloperidol was not sufficient. Next to this prospective part, retrospective data were collected from patients being treated with the combination of these medications in 2012 and 2013. The primary endpoint of this study was the fraction of non-delirious hours during the treatment of clonidine or dexmedetomidine. The CAM-ICU score was used to determine these fractions. Patients were screened until they scored negatively on the CAM-ICU for three days in a row. The first negative CAM-ICU score of these three days corresponds with the end of a delirium episode, followed by time-to-event analysis. Secondary endpoint was the effect of the α-agonist on different types op delirious IC-patients. Results: From the 25th of November 2013 till the 7th of February, 343 intensive care patients were screened in the Isala Clinics Zwolle, the Netherlands. Only one patient was randomized into the dexmedetomidinegroup, so statistical analysis did not take place. For retrospective analysis, 14 patients (clonidine n=7; dexmedetomidine n=7) met the inclusion criteria. Patients treated with clonidine showed a higher fraction of non-delirious hours during the treatment than dexmedetomidine patients (58,2% vs. 39.6% p=0,141). Patients after cardiac surgery had less response on treatment with a α2-agonist. Delirious patients, admitted for medical reasons to the ICU, responded better on treatment with clonidine compared to dexmedetomidine (p=0,088). There were not enough patients that reached the end of a delirium episode, so time-to-event analysis did not take place. Conclusion: There is no evidence or trend visible that indicates that treatment with one of these α2-agonists is more effective in patients with a haloperidol-resistant delirium. Clonidine may have a more positive effect on delirious patients admitted to the ICU for ‘medical reasons’. Because dexmedetomidine is far more expensive, treatment with clonidine may be preferred for financial and socioeconomic considerations until other studies are performed with more evidence.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kieft, Dr. H. internist-intensivist and Afdeling Intensive Care and Isala te Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:43 |
| Last Modified: | 25 Jun 2020 10:43 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/507 |
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