Delirium in the ICU: an overview

Abstract

Delirium is characterized by a disturbance of consciousness with accompanying change in cognition. Delirium typically manifests as a constellation of symptoms with an acute onset and a fluctuating course. Delirium is extremely common in the intensive care unit (ICU) especially amongst mechanically ventilated patients. Three subtypes have been recognized: hyperactive, hypoactive, and mixed. Delirium is frequently undiagnosed unless specific diagnostic instruments are used. The CAM-ICU is the most widely studied and validated diagnostic instrument. However, the accuracy of this tool may be less than ideal without adequate training of the providers applying it. The presence of delirium has important prognostic implications; in mechanically ventilated patients it is associated with a 2.5-fold increase in short-term mortality and a 3.2-fold increase in 6-month mortality. Nonpharmacological approaches, such as physical and occupational therapy, decrease the duration of delirium and should be encouraged. Pharmacological treatment for delirium traditionally includes haloperidol; however, more data for haloperidol are needed given the paucity of placebo-controlled trials testing its efficacy to treat delirium in the ICU. Second-generation antipsychotics have emerged as an alternative for the treatment of delirium, and they may have a better safety profile. Dexmedetomidine may prove to be a valuable adjunctive agent for patients with delirium in the ICU.

Incidence and risk factors for delirium development in ICU patients - a prospective observational study

“…The 26.1% incidence of delirium found in this study corresponds to a number of previous reports 16,21 . However, it is much lower than the incidence of up to 80% presented by other authors [1][2][3]39 . This discrepancy may be due to a variety of other factors:…”

“…Delirium still does not receive enough clinical attention, although it is a significant factor among those with a poor prognosis. Patients with delirium have longer hospital stays and show a 2.5-fold increase in short-term and a 3.2-fold increase in long-term mortality [1][2][3][4][5][6][7] . Based on the changes in psychomotor behaviour there are three subtypes of recognized delirium: hyperactive, hypoactive and mixed delirium.…”

Knowledge on Intensive Care Delirium among Nurses at Hospital, Nepal

“…However, there was a statistically significant association between the knowledge level and 'duration of work experience' (p=0.010) and 'training attended on the ICU delirium' (p=0.001). 14 and is a serious problem that has recently attracted much attention. 13 The present study evaluated the knowledge of nurses on ICU delirium in a Nepalese tertiary care teaching hospital.…”

Are Melatonin and its Agonist the Natural Solution for Prevention of Delirium in Critically Ill Patients? A Review of Current Studies

“…Delirium could be classified to 3 subtypes, including hyperactive, hypoactive, and mixed-type, based on the systematic clinical observation of hospitalized patients (32)(33)(34). In non-ICU patients, hyperactive delirium is recognized, while it is not observed in older patients (33,35).…”