Refractory hyperactive delirium in the dying: pharmacological management

Area of Science:

• Palliative Medicine
• Geriatric Medicine
• Clinical Pharmacology

Background:

• Delirium, particularly hyperactive delirium, is common in advanced illness and can cause distress at the end of life.
• Effective pharmacological management strategies for hyperactive delirium in Australian palliative care settings are not well-documented.
• This study addresses a gap in understanding current practices for managing this severe symptom.

Purpose of the Study:

• To describe the pharmacological management of hyperactive delirium in patients at the end of life.
• To provide insights into medication use within an Australian inpatient palliative care unit.

Main Methods:

• A retrospective audit was conducted on patient deaths from October 2019.
• Medications of interest (MOI) used in the palliative care unit (PCU) were identified.
• Clinical notes were reviewed to detail the use of MOI for hyperactive delirium.

Main Results:

• Forty patients were included in the audit.
• Midazolam was the most commonly used medication, prescribed in 57.5% of cases.
• The most frequent combination therapy involved midazolam and levomepromazine.

Conclusions:

• This audit represents the first published description of pharmacological interventions for severe hyperactive delirium requiring sedation in an Australian PCU.
• Findings provide a baseline understanding of current medication practices for this critical symptom.
• Further research may explore optimal drug regimens and patient outcomes.