The Importance of Diagnosing and Managing ICU Delirium
Abstract
ICU delirium represents a form of brain dysfunction that in many cohorts has been diagnosed in 60 to 85% of patients receiving mechanical ventilation. This organ dysfunction is grossly underrecognized because a majority of patients have hypoactive or "quiet" delirium characterized by "negative" symptoms (eg, inattention and a flat affect) not alarming the treating team. Hyperactive delirium, formerly called ICU psychosis, stands out because of symptoms such as agitation that may cause harm to self or staff, but is actually rare relative to hypoactive delirium and associated with a better prognosis. Delirium is often incorrectly thought to be transient and of little consequence. After adjusting for numerous covariates, delirium is a strong, independent predictor of prolonged length of stay, reintubation, higher mortality, and cost of care. Expanded work on patient safety and recommendations by professional societies have established the importance of delirium monitoring and recommended it as standard practice in ICUs all over the world. This evidence-based review for physicians, nurses, respiratory therapists, and pharmacists will outline why it is imperative that patients be routinely monitored for delirium. This review will discuss modifiable risk factors for delirium, such as metabolic disturbances or potent sedative and analgesic medications. Attention to mitigating risk factors, along with recommended pharmacologic approaches such as antipsychotic medications, may provide resolution of delirium in some patients, while others will persist with refractory brain dysfunction and long-term cognitive impairment following critical illness.
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Many risk factors for behavioral disorders in the critically ill have been identified, including history of hypertension and alcoholism, higher severity of acute disease, and clinical effects of sedative and analgesic agents.
“Many risk factors, such as history of hypertension and alcoholism, higher severity of acute disease, and clinical effects of sedative and analgesic agents, have been identified in the literature [12].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [12]
Delirium and agitation in critically ill patients are associated with increased morbidity and risk of mortality.
“Behavioral disorders such as delirium and agitation in the critically ill occur with a high frequency, ranging from 15% to 80% of patients, and have been associated with increased morbidity and risk of mortality [7-13].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [12]
Delirium and agitation occur frequently in critically ill patients, with reported frequencies of 15% to 80%.
“Behavioral disorders such as delirium and agitation in the critically ill occur with a high frequency, ranging from 15% to 80% of patients, and have been associated with increased morbidity and risk of mortality [7-13].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [12]
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Delirium in the Older Emergency Department Patient: A Quiet Epidemic
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- Authors
- Pun, B. T., & Ely, E. W.
- Affiliations
- Vanderbilt University (US)
- ORCID
- Ely, E. Wesley
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2007-08
- Volume
- 132
- Issue
- 2
- Pages
- 624-636
- ISSN
- 0012-3692 (ISSN-L)
- OpenAlex
- W2122672649
- Cited by
- 287
- References
- 88
- Citations by year
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- FWCI
- 2.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CHEST Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (AG 01023-01A1, K23AG001023, R01 AG072701A1)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- ICU delirium, hypoactive delirium, hyperactive delirium, mechanical ventilation, delirium risk factors, metabolic disorders, antipsychotic drugs, delirium monitoring, length of hospital stay, mortality, cost of care, patient safety
- MeSH terms
- Delirium, Diagnosis, Differential, Humans, Respiration, Artificial, Respiratory Care Units, Respiratory Insufficiency, Risk Factors, Antipsychotic Agents
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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