The Scottish Intercollegiate Guidelines Network (SIGN) 157: Guidelines on Risk Reduction and Management of Delirium

Abstract

The Scottish Intercollegiate Guidelines Network (SIGN) guideline on delirium is a major advance on existing guidelines on this condition. This is particularly important given the evidence it is frequently under-diagnosed and inadequately managed despite being common and frequently associated with significant patient and carer distress and poor outcomes. The guidelines recommend using the 4A’s test to help detect delirium. A bundle of mostly non-pharmacological therapies minimise the risk of developing delirium and can help those who develop the condition. The importance of medical optimisation by an experienced professional in those at risk of delirium is highlighted with new recommendations for people in intensive care and surgical settings. There is guidance on follow-up of people with delirium, which should become routine. This commentary piece focusses on areas with the greatest potential to improve the experience and outcomes of those with delirium, and briefly discusses areas of ongoing uncertainty.

Antipsychotics for preventing and treating delirium: not recommended

“…The conclusions from the most recent reviews are in line with the Society of Critical Care Medicine guidelines6 and the Scottish Intercollegiate Guidelines Network 7. However, they are inconsistent with the UK’s National Institute for Health and Care Excellence (NICE) guidance, which recommends that ‘if a person with delirium is distressed or considered a risk to themselves or others, and verbal and non-verbal de-escalation techniques are ineffective or inappropriate, consider giving short-term (usually for 1 week or less) haloperidol’ 8…”

Neurological consequences of COVID-19 and brain related pathogenic mechanisms: A new challenge for neuroscience

“…c) Confusion : signs of confusion were also detected in COVID-19 patients, involving delirium, acute or chronic confusional state, acute brain failure or acute encephalopathy impaired consciousness, disorientation, lack of attention, agitation and other cognitive problems ( Soiza and Myint, 2019 ). One sign of encephalopathy reported was mild or moderate confusion ( Abenza Abildúa et al, 2021 ).…”

CSF neurofilament light levels predict hippocampal atrophy in cognitively healthy older adults

“…The pathophysiology of delirium is still not understood, which limits our ability to design therapeutic interventions, and no established pharmacological prevention or treatment measures for delirium exists (416)(417)(418)(419). Multicomponent non-pharmacological interventions are still the mainstay for both prevention and treatment of delirium (420,421), although they are mainly documented to be effective for prevention of delirium (419,422,423).…”