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. 2026 Jan;81(1):41-50.
doi: 10.1111/anae.16728. Epub 2025 Aug 11.

Delirium identification, prevention and management in intensive care units in England, Wales and Northern Ireland: a survey of practice

Ben Gibbison  1 , Amelia Francis Johnson  2 , Kathryn M Rowan  2 , Roxanne Parslow  1 , Andrew J Moore  1 , Sarah C Smith  3 , James Long  4 , Molly Potter  4 , Maria Pufulete  1 ; OPTIC Study Group
Collaborators, Affiliations

Delirium identification, prevention and management in intensive care units in England, Wales and Northern Ireland: a survey of practice

Ben Gibbison et al. Anaesthesia. 2026 Jan.

Abstract

Introduction: Delirium is the most common sign of acute brain dysfunction and is prevalent in ICUs. This work is part of a UK National Institute of Health and Social Care Research-funded Programme Development Grant to identify optimal approaches to prevent, identify and manage ICU delirium in the UK. This survey aimed to provide a baseline for contemporary practice.

Methods: A structured online survey was designed and sent to all ICUs in England, Wales and Northern Ireland, identified through the Intensive Care National Audit and Research Centre Case Mix Programme. Participants were asked to provide a response that reflected ICU-level care.

Results: The ICU participant response rate was 249/268 (93%). Of these, 222/249 (89%) ICUs screened for ICU delirium routinely and 208/222 (94%) used the CAM-ICU tool. Delirium care packages were applied by 125/249 (50%) ICUs, but 81/125 (68%) conveyed that this was not consistent for all patients. Both antipsychotics and benzodiazepines are used commonly to manage delirium. All respondents stated that early mobilisation; early removal of invasive catheters; maintenance of hearing aids/glasses; regular mealtimes; and daytime activity were used as non-pharmaceutical delirium management strategies. Enhanced follow-up was reported by 195/249 (79%) respondents, either routinely or for selected cases.

Discussion: Only half of UK ICUs use a standardised care package to prevent and manage ICU delirium, with inconsistent implementation. Future work should focus on the development and evaluation of an evidence-based and sustainable care package.

Keywords: delirium; intensive care.

Plain language summary

Delirium is a common problem in people who are very sick and staying in intensive care units (ICUs). It means the brain is not working properly for a short time. This project, supported by health research in the UK, wants to find the best ways to stop, find and treat delirium in ICUs. This survey helped us understand what ICUs are currently doing. We made an online survey and sent it to all ICUs in England, Wales and Northern Ireland. The list of ICUs came from a group that tracks ICU care. We asked ICU teams to answer questions about how they care for their patients. Out of 268 ICUs, 249 (93%) replied: 222 (89%) said they regularly check patients for delirium and 208 (84%) of those used a tool called CAM‐ICU to help with this. Half of the ICUs (125 out of 249) said they use special care plans to help with delirium, but most of those said the care was not the same for every patient. Many ICUs use medicines like antipsychotics and benzodiazepines to treat delirium. All ICUs said they also try non‐drug ways to help, like helping patients move early, removing tubes quickly, making sure patients have their hearing aids or glasses, giving meals on time and helping them do things during the day. 195 ICUs (almost 80%) said they give extra follow‐up care to some or all patients after they leave the ICU. Only about half of UK ICUs use a standard plan to prevent and treat delirium, and not all patients get the same care. In the future, we need to make a care plan that works well, is based on good evidence and can be used the same way in every ICU.

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Figures

Figure 1
Figure 1
Survey response flow diagram.
Figure 2
Figure 2
Pharmacological strategies used (black) or not used (grey) to manage delirium in ICUs (n = 116). (a) Antipsychotics; (b) benzodiazepines; (c) non‐benzodiazepine sedatives; (d) sedation strategies. Numerical data available in online Supporting Information Table S3.
Figure 3
Figure 3
Non‐pharmacological strategies used (black) or not used (grey) to manage delirium in ICUs (n = 116). Numerical data available in online Supporting Information Table S4.
See this image and copyright information in PMC

References

    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders (DSM‐5®), 5th edn. Washington, D.C.: American Psychiatric Association Publishing, 2013.
    1. World Health Organization . ICD‐10: International statistical classification of diseases and related health problems: 10th revision. 2016. https://iris.who.int/handle/10665/246208 (accessed 15/07/2025).
    1. NHS England . Hospital episode statistics. Admitted patient care – critical care. https://digital.nhs.uk/services/hospital‐episode‐statistics (accessed 01/07/2025).
    1. Pugh RJ, Bailey R, Szakmany T, et al. Long‐term trends in critical care admissions in Wales. Anaesthesia 2021; 76: 1316–1325. 10.1111/anae.15466. - DOI - PMC - PubMed
    1. Public Health Scotland Audit of critical care. 2022. https://publichealthscotland.scot/publications/audit‐of‐critical‐care‐in... (accessed 01/07/2025).

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