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Delirium in the intensive care unit (ICU) is exceedingly common, and risk factors for delirium among the critically ill are nearly ubiquitous.
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Addressing modifiable risk factors including sedation management, deliriogenic medications, immobility, and sleep disruption can help to prevent and reduce the duration of this deadly syndrome.
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The ABCDE approach to critical care is a bundled approach that clinicians can implement for many patients treated in their ICUs to prevent the adverse outcomes
Preventing Delirium in the Intensive Care Unit
Section snippets
Key points
Risk factors for delirium
The average medical ICU patient has 11 or more risk factors for developing delirium,11 which can be divided into baseline (predisposing) and hospital-related (precipitating) factors.21 Baseline risk factors are those relating to a patient’s underlying characteristics and comorbidities, and hospital-related factors are those relating to the patient’s acute illness, its treatment, and ICU management (Table 1). These risk factors combine to cause delirium in a given patient such that a highly
Delirium prevention in non-ICU patients
Multicomponent strategies to prevent the development of delirium have yet to be fully developed and studied in the ICU, but an overview of strategies for delirium prevention that have been examined carefully in other populations in which delirium is prevalent, namely hospitalized elderly patients and those undergoing hip-fracture repair (Fig. 1), is likely informative for ICU clinicians despite the current paucity of evidence in this setting. Inouye and colleagues,22 for example, studied a
Delirium prevention in ICU patients
On the whole, the constellation of risk factors for delirium affecting individual ICU patients varies from patient to patient and thus an individualized strategy for delirium prevention should be sought. Nonetheless, 3 risk factors in particular, sedatives, immobility, and sleep disruption, are widespread in the ICU as a result of clinical practice habits in most ICUs and therefore serve as important targets for delirium prevention. In addition, antipsychotics and cholinesterase inhibitors
Summary
Delirium in the ICU is exceedingly common, and risk factors for delirium among the critically ill are nearly ubiquitous. Nevertheless, addressing modifiable risk factors including sedation management, deliriogenic medications, immobility, and sleep disruption can help to prevent and reduce the duration of this deadly syndrome. The ABCDE approach to critical care is a bundled approach that can be implemented by clinicians for many patients treated in their ICUs to prevent the adverse outcomes
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Funding source: NIH (Grant numbers: K23AG034257; T32HL087738).
The authors have no financial conflicts to disclose.