Can intensive care unit delirium be prevented and reduced? Lessons learned and future directions

Abstract

Delirium is a form of acute brain injury that occurs in up to 80% of critically ill patients. It is a source of enormous societal and financial burdens due to increased mortality, prolonged intensive care unit (ICU) and hospital stays, and long-term neuropsychological and functional deficits in ICU survivors. These poor outcomes are not only independently associated with the development of delirium but are also associated with increasing delirium duration. Therefore, interventions should strive both to prevent the occurrence of ICU delirium and to limit its persistence. Both patient-centered and ICU-acquired risk factors need to be addressed early in the ICU course to maximize the efficacy of prevention strategies and to improve long-term outcomes of ICU patients. In this article, we review strategies for early detection of patients who are delirious and who are at high risk for developing delirium, and we present a clinically useful ICU delirium prevention and reduction strategy for clinicians to incorporate into their daily practice.

Figures

Figure 1.

Risk factors for intensive care unit (ICU) delirium.

Figure 2.

A clinically useful delirium prevention and reduction protocol. This proposed approach incorporates principles of intensive care unit (ICU)- and patient-level delirium prevention and reduction assembled from multiple evidence-based sources but has not yet been tested in a critically ill population. *If not contraindicated. CAM-ICU = Confusion Assessment Method-ICU; ISDSC = Intensive Care Delirium Screening Checklist.

Figure 3.

Intensive Care Unit (ICU)-level delirium prevention strategies are interconnected. BPS = Behavioral Pain Scale; CPOT = Critical-Care Pain Observation Tool; IV = intravenous.