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Review
. 2023 Feb 6;12(4):1273.
doi: 10.3390/jcm12041273.

Sepsis-Associated Delirium: A Narrative Review

Rina Tokuda  1 , Kensuke Nakamura  2 , Yudai Takatani  3 , Chie Tanaka  4 , Yutaka Kondo  5 , Hiroyuki Ohbe  6 , Hiroshi Kamijo  7 , Kosuke Otake  8 , Atsuo Nakamura  9 , Hiroyasu Ishikura  10 , Yu Kawazoe  11 , J-Stad Japan Sepsis Treatment And Diagnosis Study Group
Affiliations
Review

Sepsis-Associated Delirium: A Narrative Review

Rina Tokuda et al. J Clin Med. .

Abstract

Delirium is characterized by an acutely altered mental status accompanied by reductions in cognitive function and attention. Delirium in septic patients, termed sepsis-associated delirium (SAD), differs in several specific aspects from the other types of delirium that are typically encountered in intensive care units. Since sepsis and delirium are both closely associated with increased morbidity and mortality, it is important to not only prevent but also promptly diagnose and treat SAD. We herein reviewed the etiology, pathogenesis, risk factors, prevention, diagnosis, treatment, and prognosis of SAD, including coronavirus disease 2019 (COVID-19)-related delirium. Delirium by itself not only worsens long-term prognosis, but it is also regarded as an important factor affecting the outcome of post-intensive care syndrome. In COVID-19 patients, the difficulties associated with adequately implementing the ABCDEF bundle (Assess, prevent, and manage pain; Both spontaneous awakening and breathing trials: Choice of analgesia and sedation; Delirium assess, prevent, and manage; Early mobility and exercise; Family engagement/empowerment) and the need for social isolation are issues that require the development of conventional care for SAD.

Keywords: COVID-19; delirium; post-intensive care syndrome; sepsis.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
The clinical features of delirium.
Figure 2
Figure 2
(A) Neurotransmitter of consciousness and arousal system. (B) Etiological factors of delirium. 5-HT, 5-hydroxytryptamine; ACh, acetylcholine; BF, basal forebrain; His, histamine; LC, locus coeruleus; LDT, laterodorsal tegmental nucleus; NA, noradrenaline; PPT, pedunculopontine tegmentum; TMN, tuberomammillary nucleus.
Figure 3
Figure 3
Subtypes of delirium.
Figure 4
Figure 4
Prevention and treatment of delirium in sepsis-associated delirium.
See this image and copyright information in PMC

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