Chlorpromazine in Delirium FTW!

by Drew Rosielle (@drosielle)David Hui, Eduardo Bruera, and colleagues havepublished another important delirium trial out of MD Anderson which I thought was worth blogging about in detail.In some ways it ' s related to thesame group ' s RCT a few years ago of lorazepam added to haloperidol for agitation in hospitalized advanced cancer patients with delirium (showing the lorazepam quite effectively reduced agitation via presumably a sedating effect). As I pointed out in the Palllimed post about that trial, while they labeled their patient group as ' agitated delirium in advanced cancer ' , in essence it was really a sedation for terminal delirium trial as most patients only lived a few days, but a casual reader of the study might not realize that and think they were finding that lorazepam is a disease-modifying therapy for delirium. Which it is not, discrete exception aside (alcohol withdrawal?).This is an important distinction, as I think there ' s been a sort of confusion over the years in our discussions about delirium and even research about it between disease-modifying therapy for delirium and essentially palliative-focused therapies to reduce distressing aspects of delirium (primarily agitation). Eg, a drug or drug combo or other intervention that reverses delirium / shortens delirium / returns normal cognition vs a therapy that reduces agitation (because while you could reduce agitation by ' fixing ' the delirium you could also do it by sedating the patient). When and w...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Source Type: blogs