Evaluation and Treatment of Agitation in the Intensive Care Unit

Abstract

Agitation in the intensive care unit (ICU) patient is a complication of severe medical illness that requires prompt attention and treatment. The first step in managing an agitated ICU patient is a thorough investigation for factors that may cause or predispose to the agitated state. This entails detailed review of the history and available laboratory data as well as examination of the patient's physical and mental status. Important factors that may contribute to the development of agitation include (1) the presence of delirium or psychosis; (2) the type of ICU setting (e.g., coronary, surgical, respiratory, or medical); (3) a history of psychiatric disorder; (4) a history of central nervous system disorder; and (5) patients' personalities, which affect their reactions to illness and its treatment. The treatment of agitation is then based on its identified causes. The principles of treatment include (1) correction of metabolic and systemic abnormalities, (2) elimination of drug toxicity, (3) treatment of drug withdrawal, (4) maximization of the patient's comfort, and (5) use of neuroleptic medication. Medically oriented psychiatric consultants can help to organize the evaluation and management of the agitated patient and can assist staff members in dealing with their emotional reactions to difficult management problems.