The therapy consists of various measures. For all elderly or general patients in intensive care units, basic measures to maintain orientation (glasses, hearing aids) should be carried out. A regular and extended mobilisation, the avoidance of dehydration, as well as a balanced diet and the maintenance of the sleep-wake rhythm can prevent the development of delirium or significantly improve the course.
An individually adapted pain therapy and oxygen administration can also improve the state of confusion. A timely therapy of the underlying disease, e.g. antibiotic administration in case of sepsis, has a positive influence on the psychological state. The drug therapy of a postoperative delirium is often difficult.
If a certain drug can be identified as a triggering factor, this drug must be discontinued immediately and another substance must be used. The administration of neuroleptics for prophylaxis in older patients is discussed in various studies prior to heart surgery. Olanzapine, for example, has been shown to be quite effective, but is not officially approved for this purpose (off-label use). Antipsychotics such as haloperidol in combination with quetiapine, as well as risperidone or olanzapine are also not officially approved but are still used in some cases, but only under strict ECG control. More information about neuroleptics can be found here.
The relatives can do this
Relatives are often the first to recognise when “something is wrong” with a known person. The postoperative delirium can develop slowly or as an atypical variant, so that doctors and nursing staff can only make the diagnosis later. If you suspect that something is wrong, talk to the medical staff and describe the observed changes.
If the diagnosis has already been made, it is important to be there for the affected person. Bringing up-to-date photos or playing your favourite music can help to regain orientation. If the family member does not react differently than expected or insists on a presentation, be lenient, do not discuss.
Try again at a later time or try to steer the conversation to a different topic. If you behave aggressively, self-protection is especially important. Never try to hold on to your relative, you can hurt him or her or yourself very badly. Try to stay calm and do not take anything personally, usually the delirium will subside after a few days.