The future of intensive care: delirium should no longer be an issue

Abstract

In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A–F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a ‘home-like’ (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.

Correction to: The future of intensive care: delirium should no longer be an issue

“…Following publication of the original article [ 1 ], the authors identified a citation error in the Future Delirium Monitoring section and the author name Shawniqua Williams Roberson. The family name contained an error.…”

“…The citation and reference and author group has been updated in this correction article and the original article [ 1 ] has been corrected.…”

Knowledge, attitudes and practices of ICU nurses regarding subsyndromal delirium among 20 hospitals in China: a descriptive cross-sectional survey

“… 12 13 More delirium occurs when delirium monitoring is reduced. 13 Therefore, as a precursor state of delirium, timely prevention and detection of SSD are of great significance to patients. 12 14 …”

“…12 13 More delirium occurs when delirium monitoring is reduced. 13 Therefore, as a precursor state of delirium, timely…”

The authors reply

“…Importantly, advances in organizational safety should contribute to reducing the administrative burden of clinicians, incorporate evidence-based strategies, and leverage the development of an “intelligent clinical environment” (3, 4). This environment would promote a high-level of organizational safety in the ICU, intended to reduce clinicians’ cognitive load, minimize diagnostic and treatment errors in the ICU, and facilitate active participation and inclusion of patients and families within care teams at the bedside (3, 5). The paradigm is shifting in the critical care environment.…”