Chest. 2021 Jun 5:S0012-3692(21)01091-6. doi: 10.1016/j.chest.2021.06.002. Online ahead of print.
Delirium is a serious and complex problem facing critically ill patients, their families, and the healthcare system. When it develops, delirium is associated with prolonged hospital stays, increased costs, and long-term cognitive impairment in many patients. In this article, we use a clinical case to discuss our approach to delirium prevention and treatment in the intensive care unit (ICU). We believe that an effective strategy to combat delirium requires implementation and adherence to a pain and sedation protocol as part of bundled care, use of a validated tool to detect delirium when present, and a focus on non-pharmacologic care strategies including reorientation, early mobility, and incorporating family into care when possible. At present, the evidence does not support the routine administration of medications to prevent or treat delirium. A pharmacologic approach may be needed for agitated delirium and we discuss our evaluation of the evidence for and against particular medications. While delirium can be a distressing problem, there is evidence that it can be addressed through careful attention to prevention, detection, and minimizing the long-term impact on patients and their families.