Pharmacological approach to delirium in elderly critically ill patients: an integrative review

Abstract

Intensive Care Unit (ICU) is characterized by critically ill patients, with approximately 60% elderly. In this context, delirium emerges as a frequent and clinically significant complication due to its association with increased morbidity and mortality. It is characterized by an acute alteration in various cognitive and behavioral aspects, which can be hyperactive, hypoactive or mixed. Strategies for managing delirium include non-pharmacological approaches that require collaboration among the multidisciplinary team, family, and patient, as well as often complex pharmacological interventions. This study aims to identify the main pharmacological options currently used for managing delirium in elderly patients in ICUs. This is an integrative review that searched for studies published from 2019 to 2023 in the MEDLINE, SciELO, and BVS databases, in English, Portuguese, and Spanish, using the terms delirium, elderly, ICU, and pharmacological treatment. Studies with inaccessible full-text and those including participants under 60 years old were excluded. Ten relevant studies were selected for this topic. Delirium management in elderly ICU patients often involves the use of antipsychotics such as haloperidol, quetiapine, olanzapine and lurasidone, other medications like dexmedetomidine, valproic acid, melatonin, and measures that include reducing the use of anticholinergics and benzodiazepines. There are no statistically significant results proving the benefit of most of these medications for the elderly, except for dexmedetomidine, which showed a reduction in delirium incidence and ICU stay, despite increasing the risk of bradycardia. Complementary measures, such as reducing medications that precipitate delirium and early reconciliation of neuropsychiatric medications, appear promising. New studies are needed to confirm the safety and efficacy of these therapeutic options.