<< Managing Delirium In The Emergency Department: Tools For Targeting Underlying Etiology

Controversies And Cutting Edge

The National Institutes of Health Task Force on Research in Emergency Medicine has identified specific areas of delirium requiring further research, including the following: assessment of delirium and thresholds for involuntary treatment; better definition of outcomes, including calming and sedation; development and efficacy of nonpharmacological interventions; the study of the safety and efficacy of pharmacological interventions, physical restraints, and other interventions; and new treatments for delirium.108 Regarding prophylaxis in the ED with pharmacological agents, a Dutch randomized controlled multicenter study evaluating the efficacy of haloperidol for the prevention of delirium in pa-tients admitted through the ED (HARPOON Trial) has been proposed.109 Identified in the literature review of pharmacological management, further research is needed to delineate the optimal management of delirium and undifferentiated agitation in ED settings and in the elderly; the safety of droperidol for use in the ED setting; the utility, safety, and efficacy of atypical antipsychotics in the ED setting; and the minimum effective dose for ketamine use in the prehospital and ED setting. Further research is also necessary to identify the combinations of therapy that are optimal for particular subpopulations. Finally, due to the controversy over the FDA black box warnings issued for the typical and atypical antipsychotics, the FDA plans to revisit this issue. 

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