Delirium in the intensive care unit

Abstract

Delirium is not only a mental change but also a complex clinical syndrome with multiple pathophysiological changes. Delirium is an acute brain dysfunction accompanied by change or fluctuation of basal mental status, loss of attention with disorganized thinking, or altered level of consciousness. Although healthcare professionals realize the importance of recognizing delirium, it frequently goes unrecognized in the intensive care unit. Acute delirium is associated with increased mortality, morbidity, length of stay, and healthcare costs in intensive care units and hospitals. The consequences of delirium are long-term cognitive impairment, functional disability, post-discharge cognitive dysfunction, and institutionalization. Critical illness-related delirium can affect the diagnosis and treatment of primary diseases and disappears with the improvement of primary diseases. In the intensive care unit, delirium has been reported in 40% to 60% of non-ventilated patients and up to 50% to 80% of critically ill patients undergoing mechanical ventilation. Recent investigations have shown that delirium is preventable in 30-40% of cases. Available sedation and delirium monitoring instruments allow clinicians to recognize these forms of brain dysfunction. Multiple management strategies such as ABCDE, eCASH, and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.