Truth Be Told or Still Not Sold? The Case for Benzodiazepines in the Palliative Management of Delirium (VT103)

Outcomes 1. Recognize where and when benzodiazepines can benefit delirium management 2. Explain the evidence base for the use of benzodiazepines in the palliative treatment of delirium 3. Identify the patient population that will benefit from benzodiazepine use for the palliation of delirium The current palliative management of delirium involves identification of reversible causes of delirium, nonpharmacologic measures, and pharmacologic interventions for palliation. Clinicians reserve pharmacologic interventions for cases of hyperactive delirium or refractory delirium. Specific pharmacologic agents treating delirium have typically involved using drugs from the neuroleptic class. Often families request sedation for their loved one, complicating neuroleptic choice. Early randomized controlled trials found that benzodiazepines cause worsening delirium. Other research showed that benzodiazepines and central nervous system depressants cause significant complications in the elderly, leading to further avoidance. The avoidance of benzodiazepines continued as guidelines warned of their use in delirium except in the case of alcohol withdrawal. Recent randomized controlled trials suggest that benzodiazepines are effective when sedation is required as part of the delirium treatment strategy. There is also evidence for their benefit as breakthrough agents for delirium. As benzodiazepines are potent sedatives, clinicians need to carefully weigh the risks and benefits before prescribing benzodiazepines in patients with delirium and discuss the goals of care with family caregivers and patients (if possible). Identifying when to use, how to use, and what patients will benefit from benzodiazepines becomes essential. To provide guidance, a panel of palliative care specialists and palliative pharmacologists, through case presentation didactics and audience participation, will enable attendees to explain the current evidence for the use of benzodiazepines in delirium from randomized controlled trials, identify optimal benzodiazepines to use for delirium based on their pharmacology, recognize where and when benzodiazepines can benefit delirium management, identify the patients who will benefit most from the use of benzodiazepines for delirium, and develop communication strategies with patients and families when contemplating benzodiazepine use for delirium.