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ICU delirium

What's new

Updated 2023 AAFP and 2022 WSES/GAIS guidelines for the prevention and management of postoperative delirium and in-hospital delirium in the elderly.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of ICU delirium are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2023), the Global Alliance for Infection in Surgery (GAIS/WSES/AAST/SIAARTI 2022), the Society of Critical Care Medicine (SCCM 2022,2018,2013), and the The Scottish Intercollegiate Guidelines Network (SIGN 2019). ...
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Screening and diagnosis

Indications for screening: as per SCCM 2018 guidelines, obtain regular monitoring for delirium in critically ill adult patients.
E
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  • Choice of screening tool

Classification and risk stratification

Risk factors
As per SCCM 2018 guidelines:
Recognize that:
preexisting dementia, history of hypertension and/or alcoholism, and high severity of illness at admission are strongly associated with the development of delirium in the ICU
coma is an independent risk factor for the development of delirium in the ICU
benzodiazepine use may be a risk factor for the development of delirium in adult patients in the ICU
B
Insufficient evidence regarding the relationship between opioid (B) or propofol use and the development of delirium in adult patients in the ICU.
I

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  • Prognosis

Medical management

General principles: as per SCCM 2013 guidelines, use a multidisciplinary approach, including preprinted and/or computerized protocols and order forms, quality ICU rounds checklists, and provider education, to facilitate the management of delirium in critically ill adult patients.
B

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  • Dexmedetomidine

  • Antipsychotics

  • Statins

  • Management of sedation

  • Management of sleep disturbance

Specific circumstances

Pediatric patients, management of delirium: as per SCCM 2022 guidelines, use the preschool and pediatric Confusion Assessment Methods for the ICU or the Cornell Assessment for Pediatric Delirium as the most valid and reliable delirium monitoring tools in critically ill pediatric patients.
A
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  • Pediatric patients (management of sedation)

  • Elderly patents

  • Patients with postoperative delirium

Preventative measures

Early mobilization: as per SCCM 2013 guidelines, initiate early mobilization in adult patients in the ICU whenever feasible to reduce the incidence and duration of delirium.
B

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  • Pharmacologic prophylaxis

  • Bright light therapy

Follow-up and surveillance

Follow-up: as per SIGN 2019 guidelines, consider obtaining follow-up for psychological sequelae, including cognitive impairment, in patients experiencing delirium in the ICU.
C