Neurocritical Care
ICU Delirium — Recognition, Prevention, and Management
Delirium in the ICU: types (hypoactive, hyperactive, mixed), diagnosis using CAM-ICU and RASS, ABCDEF bundle, consequences, and treatment principles.
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Delirium is a derangement of attention and awareness that occurs over a short period of time in the intensive care setting.
Delirium is the most common mental dysfunction in the ICU.
Up to 80% of mechanically ventilated patients will have some degree of delirium.
Types of ICU Delirium
Type • Prevalence • NotesSection
Types of ICU Delirium
Type • Prevalence • Notes| Type | Prevalence | Notes |
|---|---|---|
| Hypoactive | ~75% | Commonly missed; increased mortality |
| Hyperactive | ~23% | More easily recognized |
| Mixed | Most frequent | Combination |
Diagnosis
Assess level of consciousness with RASS first • If RASS ≥ −3, assess for delirium using:Section
Diagnosis
Assess level of consciousness with RASS first • If RASS ≥ −3, assess for delirium using:- Assess level of consciousness with RASS first
- If RASS ≥ −3, assess for delirium using:
- CAM-ICU (Confusion Assessment Method for the ICU)
- ICDSC (Intensive Care Delirium Screening Checklist)
ABCDEF Bundle
Letter • Intervention • ASection
ABCDEF Bundle
Letter • Intervention • A| Letter | Intervention |
|---|---|
| A | Assess, prevent, manage pain |
| B | SAT and SBT (wake and breathe) |
| C | Choice of sedation and analgesia |
| D | Delirium: assess, prevent, manage |
| E | Exercise / Early mobility |
| F | Family engagement |
Pharmacologic Considerations
No agents have strong evidence for routine delirium prevention • Dexmedetomidine may decrease delirium vs. benzodiazepines in...Section
Pharmacologic Considerations
No agents have strong evidence for routine delirium prevention • Dexmedetomidine may decrease delirium vs. benzodiazepines in...- No agents have strong evidence for routine delirium prevention
- Dexmedetomidine may decrease delirium vs. benzodiazepines in ventilated patients
- Melatonin probably useful; needs further study
- Early mobilization reduces delirium incidence and duration
Consequences of Delirium
Longer mechanical ventilation duration • Higher device dislodgement rates • Lower 6-month survivalSection
Consequences of Delirium
Longer mechanical ventilation duration • Higher device dislodgement rates • Lower 6-month survival- Longer mechanical ventilation duration
- Higher device dislodgement rates
- Lower 6-month survival
- Long-term cognitive impairment
For additional resources: icudelirium. org
- Adapted from SurgCritCare. org for structured display and mobile use. Verify against current institutional policies and attending guidance.*