David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
The review concludes that antipsychotic medications have no beneficial effects compared with placebo in treating delirium in hospitalized adults.
An editorialist concludes that the current level of evidence is sufficient to recommend against antipsychotic medications as a treatment for delirium in most patients, but he also suggests that future research focus on whether these medications have a role in controlling behavior in agitated, delirious patients (who might otherwise be a danger to themselves or others).
This systematic review does not support the use of haloperidol for preventing delirium in hospitalized adults.
Although the analysis of 3 studies in surgical patients did show a reduction in the incidence of delirium with use of second-generation antipsychotics, the authors highlight several significant limitations of these studies and conclude that more research is needed before this practice can be recommended.
The sensitivity of blood cultures, in patients with severe manifestations of sepsis, is significantly reduced if cultures are drawn after administration of empirical antibiotics.
The study is limited because preantibiotic and postantibiotic culture procedures were not identical. In some patients, postantibiotic cultures were limited to 1 set of cultures or 2 sets of cultures from a single venipuncture site, as opposed to 2 sets from 2 sites obtained before antibiotic administration.
An editorialist highlights the tension between giving antibiotics to septic patients as soon as possible and delaying to allow for acquisition of blood cultures. His current recommendation is for clinicians to obtain blood cultures as quickly as possible before administering antibiotics to maximize culture yield.
Wesorick DH, Chopra V. Annals for Hospitalists - 15 October 2019. Ann Intern Med. 2019;171:HO1. doi: https://doi.org/10.7326/AWHO201910150
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Published: Ann Intern Med. 2019;171(8):HO1.
Delirium, Hospital Medicine, Neurology.
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