Preventing delirium in the intensive care unit

Abstract

Delirium in the intensive care unit (ICU) is exceedingly common, and risk factors for delirium among the critically ill are nearly ubiquitous. Addressing modifiable risk factors including sedation management, deliriogenic medications, immobility, and sleep disruption can help to prevent and reduce the duration of this deadly syndrome. The ABCDE approach to critical care is a bundled approach that clinicians can implement for many patients treated in their ICUs to prevent the adverse outcomes associated with delirium and critical illness.

Figure 1

Prevalence of delirium in non-pharmacologic delirium prevention trials. Inouye and colleagues studied the Hospital Elder Life Program (HELP) protocol in hospitalized elderly and found a reduction in delirium prevalence from 15% among patients in the usual care group to 9.9% among patients in the intervention group. A similar protocol, studied by Martinez and colleagues, utilized family members to deliver the non-pharmacologic interventions to acutely ill elderly patients and found a reduction in delirium prevalence from 13.3% in the usual care group to 5.6% in the intervention group. Finally, Marcantonio and colleagues found that a geriatrics consultation in patients undergoing surgical fixation of hip fractures reduced delirium from 50% in patients not receiving a consultation to 32% in patients who received a consultation.

Figure 2

In the MENDS trial dexmedetomidine significantly reduced the prevalence of delirium over time. The sample size changes with study day as patients were extubated, died, discharged from the ICU or did not have delirium assessed. Reproduced with permission from Pandharipande et al., Critical Care 2010; 14: R38.