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Open Access Highly Accessed Study protocol

Improving delirium care in the intensive care unit: The design of a pragmatic study

Noll L Campbell12347*, Babar A Khan5, Mark Farber56, Tiffany Campbell3, Anthony J Perkins3, Siu L Hui235, Greg Abernathy35, John Buckley5, Regg Sing5, Jason Tricker4, Mohammad Zawahiri3 and Malaz A Boustani235

Author Affiliations

1 Department of Pharmacy Practice, Purdue University School of Pharmacy, West Lafayette, IN, USA

2 Indiana University Center for Aging Research, Indianapolis, IN, USA

3 Regenstrief Institute, Inc., Indianapolis, IN, USA

4 Wishard Health Services, Indianapolis, IN, USA

5 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

6 Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA

7 Indiana University Health, Indianapolis, IN, USA

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Trials 2011, 12:139  doi:10.1186/1745-6215-12-139

Published: 6 June 2011

Abstract

Background

Delirium prevalence in the intensive care unit (ICU) is high. Numerous psychotropic agents are used to manage delirium in the ICU with limited data regarding their efficacy or harms.

Methods/Design

This is a randomized controlled trial of 428 patients aged 18 and older suffering from delirium and admitted to the ICU of Wishard Memorial Hospital in Indianapolis. Subjects assigned to the intervention group will receive a multicomponent pharmacological management protocol for delirium (PMD) and those assigned to the control group will receive no change in their usual ICU care. The primary outcomes of the trial are (1) delirium severity as measured by the Delirium Rating Scale revised-98 (DRS-R-98) and (2) delirium duration as determined by the Confusion Assessment Method for the ICU (CAM-ICU). The PMD protocol targets the three neurotransmitter systems thought to be compromised in delirious patients: dopamine, acetylcholine, and gamma-aminobutyric acid. The PMD protocol will target the reduction of anticholinergic medications and benzodiazepines, and introduce a low-dose of haloperidol at 0.5-1 mg for 7 days. The protocol will be delivered by a combination of computer (artificial intelligence) and pharmacist (human intelligence) decision support system to increase adherence to the PMD protocol.

Discussion

The proposed study will evaluate the content and the delivery process of a multicomponent pharmacological management program for delirium in the ICU.

Trial Registration

ClinicalTrials.gov: NCT00842608