Prevention and management of delirium in critically Ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines

Abstract

Delirium is an acute, confusional state characterized by altered consciousness and a reduced ability to focus, sustain, or shift attention. It is associated with a number of complex underlying medical conditions and can be difficult to recognize. Many critically ill patients (e.g., up to 80% of patients in the intensive care unit [ICU]) experience delirium due to underlying medical or surgical health problems, recent surgical or other invasive procedures, medications, or various noxious stimuli (e.g., underlying psychological stressors, mechanical ventilation, noise, light, patient care interactions, and drug-induced sleep disruption or deprivation). Delirium is associated with a longer duration of mechanical ventilation and ICU admittance as well as an increased risk of death, disability, and long-term cognitive dysfunction. Therefore, the early recognition of delirium is important and ICU medical staff should devote careful attention to both watching for the occurrence of delirium and its prevention and management. This review presents a brief overview of delirium and an update of the literature with reference to the 2018 Society of Critical Care Medicine Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.

The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting

“…This may indicate that the decision to extubate was more appropriate in the intensivist group. As the rate of early extubation increased and the duration of mechanical ventilation was shortened, we expected the incidence of VAP and delirium to decrease because both are associated with a longer mechanical ventilation time [14,15]. Although the incidence of VAP was lower in the intensivist group, as we expected, this difference did not reach statistical significance.…”

Prevention, diagnosis, and treatment of delirium in older adults with COVID-19. Literature review

“…Delirium prevention programs are essential in the era of COVID-19 and should not be omitted, despite the challenges related to the measures established in hospitals, such as, for example, the prohibition of visits to patients, the need to use face masks as well as personal protective equipment (PPE). Since their intervention could reduce isolation, favor daytime stimulation, regulate the sleep-wake cycle, and monitor the individual needs of the patient a key aspect is the role played by health personnel in delirium prevention (Park & Lee, 2019). For this reason, current recommendations consider the support of a caregiver/family member accompanying the OA during COVID-19 care, always using PPE, and attending for short periods (LaHue et al, 2020).…”

Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically Ill Mechanically Ventilated COVID-19 Patients

“…Delirium was identified both in the acute and in the post-ICU phases during the severe acute respiratory syndrome (SARS) and Middle-East respiratory syndrome (MERS) epidemics, with a possible detrimental effect on length of stay (37). Sedatives, analgesics, pain, psychological stressors, hypoxia, metabolic and electrolyte imbalances, infection, hyperthermia, sepsis, mechanical ventilation, light, and the use of physical restraints are well-known contributors to delirium occurrence in the ICU (38,39). Delirium is known to be associated with longer ICU stay and mechanical ventilation days as well as an increased risk of death at 6 months, disability, and long-term cognitive dysfunction (39,40).…”