Clinical pharmacist involvement within a multidisciplinary health care team during the admission medication reconciliation process demonstrated a significant improvement in patient safety and an economic benefit.

The Harris-Benedict equation multiplied by an activity factor of 1.2 is suitable for predicting REE and may be used in the absence of indirect calorimetry.

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T he inten sive care unit (ICU) can be a stressful and intimidating environment for critically ill patients. Behavioral disturbances in critically ill patients may be detrimental to the safety of patients and the nurses caring for these patients. These disturbances may manifest as ICU delirium. The development of ICU delirium can lead to dire consequences, such as an increased risk of 6-month mortality, extended ICU and hospital lengths of stay, and long-term cognitive impairment. 1-4 Critical care nurses caring for delirious patients are often the first to notice any changes in mental status or behavior; therefore, it is important for critical care nurses to have an understanding of ICU delirium. This review focuses on the prevention and recognition of delirium and provides an overview of both nonpharmacological and pharmacological methods of managing ICU delirium. What Is ICU Delirium?Delirium is derived from the Latin word de lira, meaning "off the path." Several older terms have been used to describe ICU delirium and are synonymous; these terms include sundowning, acute confusional state, ICU encephalopathy, ICU psychosis, and ICU syndrome. The Diagnostic and Statistical Manual of Mental Disorders, Version 4 defines delirium as a disturbance in level of consciousness, with a noted change in cognition, that develops over a short period of time (hours to days) and fluctuates over the course of a day. 5 The incidence of ICU delirium has been noted to range from 15% to 80%, depending on the assessment tool used and the population studied. [5][6][7][8][9] Research evaluating the pathogenesis of delirium is in its infancy; however, neurotransmitter imbalances are thought to play a major role in the development of ICU delirium-specifically, a decrease in acetylcholine and an increase in dopamine in the brain of patients with ICU delirium. 9 Other proposed mechanisms include inflammation, impaired oxidative metabolism, and availability of large neutral amino acids. Discussions on these mechanisms of injury are beyond the scope of this review, and readers are referred to a recent review on the topic. 9 What Are the Clinical Consequences of ICU Delirium?The negative impact of ICU delirium on clinical outcomes has been well described in the medical literature. In a landmark trial investigating ICU delirium in 275 adult medical and coronary ICU patients, Ely and colleagues 1 noted that the John Allen is Assistant Clinical Professor,

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