Can the devil be driven out of critically ill patients? – Introducing a new cerebroprotective treatment option

Delirium is an acute alteration in mental status characterized by confusion, inattention and a fluctuating level of arousal. It is a serious clinical problem that is associated with prolonged hospital stay and an increased risk of mortality. The pathomechanisms of delirium are not well recognized, however a disturbances in the cholinergic system, dopamine synthesis, neuronal plasticity, inflammation and oxidative stress following cerebral ischemia or hyperoxia appear a key role in this process. A lot of drugs have been tested to reduce or treat delirium. Some of them have been shown to reduce brain disorders that can cause delirium. From this point of view Cerebrolysin seems to be the most effective drugs. It improves neuronal plasticity, attenuates post-ischemia disorders, improves cholinergic activity and attenuates post-ischemic disorders reducing the severity of oxidative stress. Hence, it may be useful in prevention and treatment of delirium. A single-center study documented that Cerebrolysin significantly reduces the risk of postoperative delirium in cardiac surgery patients. The adjunctive treatment with Cerebrolysin significantly improves neuropsychological outcome in septic shock patients, reducing the risk of delirium and subsequent the length of stay in the intensive care unit. The use of Cerebrolysin
in patients undergoing abdominal surgery at high risk of delirium significantly reduced the incidence of postoperative  neuropsychological disorders and improved circadian rhythm. All these results suggest that Cerebrolysin may be effective drug for prevention and treatment of delirium in critically ill patients. Interestingly, the properties of Cerebrolysin also suggest, that its administration from the first day of treatment in the intensive care unit (ICU) may effectively prevent delirium in critically ill patients, however this hypothesis should be confirmed in a large clinical trials.