Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2011 Apr;24(2):195-201.
doi: 10.1097/ACO.0b013e3283445382.

The complex interplay between delirium, sedation, and early mobility during critical illness: applications in the trauma unit

Arna Banerjee  1 , Timothy D Girard, Pratik Pandharipande
Affiliations
Review

The complex interplay between delirium, sedation, and early mobility during critical illness: applications in the trauma unit

Arna Banerjee et al. Curr Opin Anaesthesiol. 2011 Apr.

Abstract

Purpose of review: Critically ill patients are prescribed sedatives and analgesics to decrease pain and anxiety, improve patient-ventilator dyssynchrony and ensure patient safety. These medications may themselves lead to delirium and ICU-acquired weakness, which are associated with worse clinical outcomes. This review will focus on the epidemiology of these two disease processes and discuss strategies aimed at reducing these devastating complications of critical illness.

Recent findings: Delirium and ICU-acquired weakness are associated with longer hospital stay, increased cost and decreased quality of life after discharge from the ICU. Delirium has also shown to be associated with increased mortality. Strategies aimed at reducing sedative exposure through protocols and coordination of daily sedation and ventilator cessation trials, avoiding benzodiazepines in favor of alternative sedative regimens and early mobilization of patients have all shown to significantly improve patient outcomes.

Summary: Delirium and ICU-acquired weakness are complications of critical illness associated with worse clinical outcomes and functional decline in survivors. An evidence-based approach based on the following tenets - minimization of sedative medication, particularly benzodiazepines, delirium monitoring and management and early mobilization may mitigate these complications.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

Drs Pandharipande and Girard have received honorarium from Hospira Inc. Dr. Pandharipande has also received honorarium from GlaxoSmithKline and Orion Pharma.

Figures

Figure 1
Figure 1. Confusion Assessment Method in the ICU
Copyright © 2002, E. Wesley Ely, MD, MPH and Vanderbilt University, all rights reserved
See this image and copyright information in PMC

References

    1. Jaber S, Chanques G, Altairac C, Sebbane M, Vergne C, Perrigault P, et al. A prospective study of agitation in a medical-surgical ICU: incidence, risk factors, and outcomes. Chest. 2005;128(4):2749. - PubMed
    1. Cohen I, Gallagher T, Pohlman A, Dasta J, Abraham E, Papadokos P. Management of the agitated intensive care unit patient. Critical Care Medicine. 2002;30(1):S97. - PubMed
    1. Pandharipande P, Jackson J, Ely EW. Delirium: acute cognitive dysfunction in the critically ill. CurrOpinCrit Care. 2005;11(4):360–368. - PubMed
    1. Jacobi J, Fraser G, Coursin D, Riker R, Fontaine D, Wittbrodt E. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.[see comment][erratum appears in Crit Care Med 2002 Mar;30(3):726] Critical Care Medicine. 2002;30:119–141. - PubMed
    1. Gehlbach BK, Kress JP. Sedation in the intensive care unit. CurrOpinCrit Care. 2002;8:290–298. - PubMed

Publication types