ICU delirium: an update

Abstract

Purpose of review: Delirium is frequently encountered in the ICU and is associated with significant adverse outcomes. The increasingly recognized consequences of ICU delirium should enhance efforts to improve recognition and management of this serious problem. We aim to review the recent literature on ICU delirium, including risk factors, detection, management and long-term impact of disease.

Recent findings: We present the most recent evidence on risk factors for ICU delirium and its persistence. In addition, we aim to clarify some of the confusion surrounding the tools for detection and their limitation in practice. The literature reflects long-term neurocognitive impairments following ICU delirium and supports efforts to reduce these negative outcomes using protocol-driven sedation and ventilator management. Although haloperidol is widely accepted as the preferred pharmacologic treatment for delirium, its use is not seeded in robust evidence. Limited studies reflect the safety of atypical antipsychotics for treatment but lack clear improvement in delirium-related outcomes. We place an emphasis on the use of protocols to reduce the use of sedatives, particularly benzodiazepines in the management of ICU delirium.

Summary: Delirium remains an underrecognized and underdiagnosed problem. Detection tools are readily available and easy to use. Further understanding of risk factors is needed to identify most susceptible individuals and plan management, which should include prevention and therapy based on available evidence.