ICU delirium is increasingly recognized as a major determinant of morbidity and mortality in critical care patients. It develops in around 2 out of every 3 ventilated critically ill patients. To detect ICU delirium, patients need to be actively screened using a validated tool otherwise it is likely to be missed. Good practice requires implementing routine delirium screening of all patients, a series of robust preventative measures targeted at risk factors—in particular sedation practices—treating the cause of delirium and using antipsychotics when indicated. An ABCDE bundle has been designed to improve the management of mechanically ventilated patients and improve outcomes for delirious patients.
Dunn WF, Murphy J.Death by compassion-dilemmas and opportunities in sedation delivery: iatrogenesis within a profession in denial. Chest. 2010 ;138:1034-1035.
2.
Vasilevskis EE, Ely EW, Speroff T., Pun BT, Boehm L., Dittus RSReducing iatrogenic risks: ICU-acquired delirium and weakness- crossing the quality chasm. Chest. 2010;138:1224-1233.
3.
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
4.
Page VJ, Navarange S., Gama S., McAuley DFRoutine delirium monitoring in a UK critical care unit. Crit Care.2009;13:R16.
5.
Girard TD, Jackson JC, Pandharipande PP, et al. Delirium as a predictor of long-term cognitive impairment as survivors of critical illness. Crit Care Med. 2010;38:1513-1520.
6.
Ely EW, Shintani A., Truman B., et al. Delirium as a predictor of mortality in mechanically ventilated patients in intensive care unit. JAMA. 2004 ;291:1753-1762.
7.
Inouye SKDelirium in older persons. N Engl J Med. 2006 ;354: 1157-1165.
8.
Spronk PE, Riekerk B., Hofhuis J., Rommes JHOccurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Med. 2009;35:1276-1280.
9.
Peterson JF, Pun BT, Dittus RS, et al. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc. 2006;54:479-484.
10.
Devlin JW, Fong JJ, Fraser GL, Riker RRDelirium assessment in the critically ill. Intensive Care Med. 2007;33:929-940.
11.
Pisani MA, Murphy TE, Araujo KL, Slattum P., Van Ness PH, Inouye SKBenzodiazepine and opioid use and the duration of intensive care delirium in an older population. Crit Care Med. 2009 ;37: 177-183.
12.
Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial) a randomised controlled trial. Lancet. 2008;371:126-134.
13.
Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874-1882.
14.
Jacobi J., Fraser G., Coursin D., et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med . 2002;30:119-141.
15.
Milbrandt EB, Kersten A., Kong L., et al. Haloperidol use is associated with lower hospital mortality in mechanically ventilated patients. Crit Care Med. 2005;33: 226-229.
16.
Perlis RH, Ganz DA, Avorn J., et al. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med.2005 ;353:2335-2341.
17.
Devlin JW, Roberts RJ, Fong JJ, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind placebo-controlled pilot study. Crit Care Med. 2010;38:419-427.
18.
van Eijk MM , Roes KC, Honing ML, et al. Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial . Lancet. 2010;376:1829-1837.
