Delirium in the intensive care unit: role of the critical care nurse in early detection and treatment

Abstract

Critically ill patients are at increased risk of developing delirium, which has been considered one of the most common complications of intensive care unit (ICU) hospitalization. Despite the high occurrence of delirium in the ICU, researchers have shown it is consistently overlooked and often undiagnosed. An understanding of delirium and the three clinical subtypes of hyperactive, hypoactive and mixed-type delirium that exist are key to early detection and treatment. Critical care nurses are in the frontline position to detect and monitor for risk factors that contribute to the development of delirium in the ICU. Recognition of predisposing risk factors and the elimination of precipitating risk factors for delirium can prevent the devastating short-term and long-term consequences for the critically ill patient. The importance of the use of validated assessment tools, such as the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) to detect key features of delirium development is emphasized. Recommendations to improve the practice of critical care nurses include continuing education regarding the causes, risk factors and treatments of delirium, and education sessions on the use of validated assessment tools. Early prevention strategies, such as modification of the ICU environment to promote normal sleep/wake cycles, including reduction of unit noise and nighttime interruptions, are examined as interventions to avoid the development of delirium.