Delirium in Critical Care

Abstract

This is the 2nd edition of a book about delirium in critical care published within the Core Critical Care series by Cambridge University Press, edited by Alain Vuylsteke. The authors, Professor Wesley Ely from Vanderbilt University School of Medicine in Nashville, Tennessee, USA and Dr Valerie Page from Watford General Hospital, UK, are critical care clinicians and internationally renowned experts in the field of delirium. Delirium represents an acute episode of brain failure and is a medical problem of growing concern in an ageing population in the intensive care unit and postoperatively. Improvement from surgery for elderly patients is, as of this year, one of the top ten research priorities for Anaesthesia and Perioperative Care in the UK. Currently, delirium is under-diagnosed and under-treated. This book provides clear answers to the question why delirium is important (covered in chapter 6): ‘Delirium has seriously bad outcomes, delirium is an independent predictor of mortality, delirium is a predictor of long-term cognitive impairment, ICU and hospital length of stay are increased with delirium, delirium is expensive to society, and individuals.’ Despite its small study book size, this detailed and comprehensive latest edition covers all relevant clinical and non-clinical aspects of delirium with highly relevant and interesting case reports, additional tables, figures, updated references and bullet points at the end of each chapter. Given the complexity of the subject, the authors have achieved a highly readable and accessible overview over central aspects of delirium. As the most valid and reliable diagnosis and monitoring tools, two major clinical rating scales are introduced in detail and discussed: the Confusion Assessment Method for the ICU (ICAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC). In addition, based on the latest Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, published in May 2013, the five diagnostic criteria for delirium are listed and explained in this edition. A chapter about treatment of delirium in critical care includes updated information about the use of dexmedetomidine, and in addition the controversial use of haloperidol is discussed in detail. A list of preventive measures, including avoidable risk factors, are addressed and discussed. Apart from all clinically relevant information in this pocket-sized book, I particularly enjoyed the chapter about the pathophysiology of delirium. Delirium is a result of an imbalance of neurotransmitters, with a relative cholinergic-deficient state and excess dopamine resulting in oxidative stress, and despite these insights there are currently more questions than answers about what exactly causes delirium at the cellular and molecular level. The book will be highly useful for all medical teams who look after patients in the intensive care unit, including nursing staff, anaesthetic and intensive care trainees and consultants. It should also be useful for clinical research teams interested in improving postoperative outcome in patients. Overall, the small study book ‘delirium in critical care’ is full of important information and relevant data, and the authors and the series editor should be congratulated on this excellent updated edition, an essential source of knowledge for perioperative- and intensive care teams.