{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:09:26Z","timestamp":1790136566059,"version":"4.0.1"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T00:00:00Z","timestamp":1548374400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K23AG043476"],"award-info":[{"award-number":["K23AG043476"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG034205"],"award-info":[{"award-number":["R01AG034205"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND\/OBJECTIVE<\/jats:title>\n                    <jats:p>Delirium in the intensive care units (ICUs) is prevalent, with both delirium duration and delirium severity associated with adverse outcomes. We designed a pragmatic trial to test the efficacy of a pharmacological management of delirium (PMD) bundle in improving delirium\/coma\u2010free days and reducing delirium severity among ICU patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN<\/jats:title>\n                    <jats:p>A randomized pragmatic clinical trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SETTING<\/jats:title>\n                    <jats:p>Medical, surgical, and progressive ICUs of three tertiary care hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PARTICIPANTS<\/jats:title>\n                    <jats:p>A total of 351 critically ill patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>INTERVENTION<\/jats:title>\n                    <jats:p>A multicomponent PMD bundle consisting of reducing the exposure to 20 definite anticholinergic medications and benzodiazepines and prescribing low\u2010dose haloperidol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MEASUREMENTS<\/jats:title>\n                    <jats:p>The primary outcomes were delirium\/coma\u2010free days, measured through the Richmond Agitation\u2010Sedation Scale and the Confusion Assessment Method for the ICU (CAM\u2010ICU), and delirium severity, measured through Delirium Rating Scale\u2010Revised\u201098 and the CAM\u2010ICU\u20107. Secondary outcomes were in\u2010hospital and posthospital discharge 30\u2010day mortality, ICU and hospital lengths of stay, and delirium\u2010related hospital complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      We randomized 351 critically ill delirious patients (mean age = 59.3 years [SD = 16.9 years]; 52% female, 42% African Americans) to receive the PMD bundle or usual care. There were no significant differences in median delirium\/coma\u2010free days at day 8 (PMD vs usual care = 4 [interquartile range {IQR} = 2\u20107] days vs 5 [IQR = 1\u20137] days;\n                      <jats:italic>P<\/jats:italic>\n                      = .888) or at day 30 (PMD vs usual care = 26 [IQR 19\u201029] days vs 26 [IQR, 14\u201329] days;\n                      <jats:italic>P<\/jats:italic>\n                      = .991). There were no significant differences for decrease in delirium severity at day 8, but at hospital discharge, the intervention group showed a greater reduction in delirium severity (mean decrease in CAM\u2010ICU\u20107 score for PMD vs usual care = 3.2 [SD = 3.3] vs 2.5 [SD = 3.2];\n                      <jats:italic>P<\/jats:italic>\n                      = .046). No differences were observed between groups for ICU and hospital lengths of stay, mortality, and delirium\u2010related hospital complications. Similar results were observed when analyses were limited to patients 65 years or older and 75 years or older.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION AND RELEVANCE<\/jats:title>\n                    <jats:p>Implementing the PMD bundle in the ICU did not reduce delirium duration or severity among critically ill patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>TRIAL REGISTRATION<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">clinicaltrials.gov<\/jats:ext-link>\n                      Identifier: NCT00842608. J Am Geriatr Soc 67:1057\u20131065, 2019.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.15781","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T11:11:09Z","timestamp":1548414669000},"page":"1057-1065","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":65,"title":["Pharmacological Management of Delirium in the Intensive Care Unit: A Randomized Pragmatic Clinical Trial"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4507-6968","authenticated-orcid":false,"given":"Babar A.","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Indiana University School of Medicine  Indianapolis Indiana"},{"name":"Indiana University Center for Aging Research  Indianapolis Indiana"},{"name":"Regenstrief Institute, Inc  Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Indiana University School of Medicine  Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noll L.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Indiana University School of Medicine  Indianapolis Indiana"},{"name":"Indiana University Center for Aging Research  Indianapolis Indiana"},{"name":"Regenstrief Institute, Inc  Indianapolis Indiana"},{"name":"Sandra Eskenazi Center for Brain Care Innovation at Eskenazi Health  Indianapolis Indiana"},{"name":"Department of Pharmacy Practice Purdue University College of Pharmacy  West Lafayette Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujuan","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Indiana University School of Medicine  Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark O.","family":"Farber","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Indiana University School of Medicine  Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Indiana University School of Medicine  Indianapolis Indiana"},{"name":"Department of Psychiatry, Indiana University School of Medicine  Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sikandar H.","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Indiana University School of Medicine  Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben L.","family":"Zarzaur","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Indiana University School of Medicine  Indianapolis Indiana"},{"name":"Department of Surgery Indiana University School of Medicine  Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malaz A.","family":"Boustani","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Indiana University School of Medicine  Indianapolis Indiana"},{"name":"Indiana University Center for Aging Research  Indianapolis Indiana"},{"name":"Regenstrief Institute, Inc  Indianapolis Indiana"},{"name":"Sandra Eskenazi Center for Brain Care Innovation at Eskenazi Health  Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,1,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-113-12-941"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000145587.16421.BB"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.14.1753"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-001-1132-2"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000119429.16055.92"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200904-0537OC"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181f85759"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2002.50210.x"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00019442-200102000-00011"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.162.4.457"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03530350034031"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2007.08.005"},{"issue":"2","key":"e_1_2_8_14_1","first-page":"132","article-title":"Is there a final common neural pathway in delirium? 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