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About this program
Learning objectives
Target audience
Conflict of Interest Declaration

Delirium affects up to 54% of patients treated on the intensive care unit or after surgery.
The underlying pathophysiology of delirium is not yet fully understood, but central nervous system response to systemic inflammation that involves neurohumoral and neurotransmitter systems is key to models discussed in the literature and applied to clinical study protocols. This acute and fluctuating change of cognitive function and awareness is a warning sign of an underlying condition that should draw maximum attention of the treatment team. Timely and effective treatment may reduce the duration and severity of delirium but needs a clear team-based management strategy to detect it and concerted action taken.
 
This webinar webcast focuses on strategies to detect delirium and discuss treatment and prevention options based on the example of two patients developing delirium in the ICU and in postoperative recovery.

Key Points of this Webinar webcast
 - Detect and treat postoperative and ICU delirium
 - Use clear communication and team work when managing delirium
 - Have a clear idea how to prevent delirium
 - Know the indications and limits of currently available pharmacological strategies
 - Treat the agitated delirium
 - Perform a focused and feasible assessment of patients at risk for delirium

Technical Settings
This webcast is available on PC, Tablet and Smartphone.

Content
In the ICU
The ICU case describes a 71-year-old patient with a history of diabetes, arterial hypertension, and an acute myocardial infarct who is admitted to the ICU because of acute respiratory failure caused by lobar pneumonia. The patient exhibits mental confusion and agitation since the very early phase of disease, requiring mechanical ventilation and sedation.
 - The case will be used to illustrate the importance of selecting a non-benzodiazepine agent as the appropriate sedative agent.
 - Excessively deep sedation is associated with increased mortality, and hence, the case will emphasize the need to continuously monitor the dept of sedation.
 - Agitation can be multifactorial and potential causes should be carefully evaluated.
 - If agitation is the phenotypic presentation of delirium (agitated or hyperactive delirium), an appropriate use of neuroleptic drugs is essential to dominate agitation and, at the same time, to avoid the important side-effects associated with this class of drugs.
 - Centrally to the discussion of the webinar, the case will highlight the feasibility of assessing delirium even during continuous sedation, provided that deep sedation and coma are avoided.
 - Delirium, even sedative-associated delirium, may cause long-term cognitive impairment. Therefore, its prompt recognition and assessment of potential causes are key to reduce the likelihood of severe, prolonged cognitive alterations.

In the recovery room
The recovery room case describes a 73-year-old patient who was operated with robotic prostatectomy for prostatic cancer. His medical history includes arterial hypertension but no other conditions affecting his functional preoperative state. After surgery he exhibits disorientation and reduced level of attention with fluctuating states of hyperactivity and vegetative disbalance. He scores positive on structured delirium screening.

 - The case focuses on emergence delirium and the importance of early detection and treatment.
 - We will present our team approach for identification and management of emergence delirium in the recovery room to prevent postoperative complications.
 - Intraoperative (precipitating) factors that might have facilitated emergence delirium in this patient will be evaluated
 - We will discuss the patient’s own risks (predisposing factors) for delirium that could have been identified before surgery. 

Learning Objectives

This webinar will enable anaesthesiologists to:
 - Be more aware of the concept of brain vulnerability and the risks of delirium as an independent and relevant risk for adverse treatment outcome
 - Better understand the spectrum of delirium presentations in critically ill and postoperative patients
 - Learn about the phenomenology/diagnosing of delirium in research and routine
 - Assess the risk of a patient to develop delirium during ICU treatment or after surgery
 - Use validated screening instruments to detect delirium
 - Better assess and treat patients who are at risk of delirium
 - Start early non-pharmacological and symptom-oriented pharmacological treatment
 - Realise the importance of teamwork as a strategy to manage delirium successfully   

This content is targeted at Anaesthesiologists and healthcare professionals in Perioperative and Intensive Care. Other Specialists and Healthcare Professionals who are involved in the care and management of the above patient groups.

The Scientific faculty: 
Dr. Mark Coburn 
Prof. Claudia Spies
Prof. Nicola Latronico
Dr. Friedrich Borchers

declare that the material in this webinar is free from any conflict of interest, in accordance with ESA and UEMS guidelines.

Webcast on Managing Delirium
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