ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Abstract

ICU delirium is a common medical problem occurring in patients admitted to the intensive care units (ICUs). Studies have shown that ICU delirium is associated with increased mortality, prolonged hospitalization, prolonged mechanical ventilation, costs and the occurrence of cognitive disoders after discharge from ICU. The tools available for ICU delirium screening and diagnosis are validated tests available for all members if the medical team (physicians, nurses, physiotherapists). Their use for routine patient assessment is recommended by international medical and scientific societies. They have been implemented as Pain, Agitation, Delirium (PAD) Guidelines by the Society of Critical Care Medicine. Apart from monitoring, a strategy of prevention and treatment is recommended, based on non-pharmacological approach (restoration of senses, early mobilization, physiotherapy, improvement in sleep hygiene and family involvement) as well as pharmacological treatment (typical and atypical antipsychotics and dexmedetomidine). In this article, we present the risk factors of ICU delirium, available tools for monitoring, as well as options for prevention and treatment of delirium that can be used to improve care over critically ill patients.

COVID-19: ICU delirium management during SARS-CoV-2 pandemic

“…At the heart of this safety bundle lies the brain, the most vital organ of the human body, and it has been shown now in over 25,000 patients [37,39,82,83] that higher compliance yields better survival, less delirium and coma, shorter lengths of stay, less ICU bounce-back, and lower cost of care. Implementation at the bedside of excellent delirium prevention and management should be a priority during the COVID-19 pandemic [84,85].…”

The Impact of Acute Kidney Injury in the Perioperative Period on the Incidence of Postoperative Delirium in Patients Undergoing Coronary Artery Bypass Grafting—Observational Cohort Study

“…Mental state (normal vs. delirium) was assessed daily, using the Polish version of the ICU Confusion Assessment Method (CAM-ICU) and Richmond Agitation and Sedation scale (RASS) [5]. All patients were screened for delirium twice a day, by day and night shifts of doctors and nurses, and the diagnosis of delirium was made according to the DSM-5 criteria [15].…”

“…Likewise, acute brain dysfunction is common after cardiac surgery and can be manifested as postoperative delirium (POD) or delirium in the intensive care unit (ICU Delirium) [4]. Similar to AKI, postoperative delirium can be associated with adverse short-and long-term effects, including postoperative cognitive dysfunction (POCD), and increased morbidity and mortality [5]. Postoperative delirium and other postoperative neurological disorders (e.g., coma) are common, yet they are underdiagnosed symptoms of brain dysfunction in the intensive care unit, and their mechanisms are insufficiently understood [6,7].…”

The Relationship between Selected Bioelements and Depressiveness Associated with Testosterone Deficiency Syndrome in Aging Men

“…However, due to the small number of studies regarding the relationship between depressive and cognitive disorders and chromium, and given the results presented in this paper, we consider it important to continue research on this bioelement on a larger and more diverse study group. Future studies should also include patients undergoing major surgery or treated in the intensive care unit to evaluate the role of chromium levels in postoperative cognitive disorders and postoperative delirium [35,36].…”