TY - JOUR
T1 - How We Prevent and Treat Delirium in the ICU
AU - Palakshappa, Jessica A.
AU - Hough, Catherine L.
N1 - Funding Information:
FUNDING/SUPPORT: Dr Hough is supported by National Institutes of Health grant [K24HL141526, PI].
Publisher Copyright:
© 2021 American College of Chest Physicians
PY - 2021/10
Y1 - 2021/10
N2 - Delirium is a serious and complex problem facing critically ill patients, their families, and the health care system. When delirium develops, it is associated with prolonged hospital stays, increased costs, and long-term cognitive impairment in many patients. This article uses a clinical case to discuss our approach to delirium prevention and treatment in the ICU. We believe that an effective strategy to combat delirium requires implementation and adherence to a pain and sedation protocol as part of bundled care, use of a validated tool to detect delirium when present, and a focus on nonpharmacologic care strategies, including reorientation, early mobility, and incorporating family into care when possible. At present, the evidence does not support the routine administration of medications to prevent or treat delirium. A pharmacologic approach may be needed for agitated delirium, and we discuss our evaluation of the evidence for and against particular medications. Although delirium can be a distressing problem, there is evidence that it can be addressed through careful attention to prevention, detection, and minimizing the long-term impact on patients and their families.
AB - Delirium is a serious and complex problem facing critically ill patients, their families, and the health care system. When delirium develops, it is associated with prolonged hospital stays, increased costs, and long-term cognitive impairment in many patients. This article uses a clinical case to discuss our approach to delirium prevention and treatment in the ICU. We believe that an effective strategy to combat delirium requires implementation and adherence to a pain and sedation protocol as part of bundled care, use of a validated tool to detect delirium when present, and a focus on nonpharmacologic care strategies, including reorientation, early mobility, and incorporating family into care when possible. At present, the evidence does not support the routine administration of medications to prevent or treat delirium. A pharmacologic approach may be needed for agitated delirium, and we discuss our evaluation of the evidence for and against particular medications. Although delirium can be a distressing problem, there is evidence that it can be addressed through careful attention to prevention, detection, and minimizing the long-term impact on patients and their families.
KW - critical care
KW - delirium
KW - implementation
UR - http://www.scopus.com/inward/record.url?scp=85116012404&partnerID=8YFLogxK
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U2 - 10.1016/j.chest.2021.06.002
DO - 10.1016/j.chest.2021.06.002
M3 - Review article
C2 - 34102141
AN - SCOPUS:85116012404
VL - 160
SP - 1326
EP - 1334
JO - Diseases of the chest
JF - Diseases of the chest
SN - 0012-3692
IS - 4
ER -