Optimum Sedation and Delirium Assessment in ICU

Abstract

Delirium is a common syndrome that affects up to 69% of patients in UK intensive care units (ICUs). It is effectively an acute organ failure – of the brain. Delirium is not benign – in itself it is an independent predictor of death. Delirium is associated with increased ICU and hospital length of stay, increased costs and long-term cognitive impairment. In the ICU, hypoactive delirium is common, easily missed and associated with a worse prognosis than hyperactive and mixed motoric subtypes of delirium. Routine screening with a validated assessment tool, such as the CAM-ICU, is recommended. To assess for delirium reliably, patients need to be responsive to a verbal stimuli, eg able to open their eyes in response to hearing their name. Analgesia-based sedation, which avoids over-sedation and aims to ensure patients are calm, cooperative and communicative, enables delirium to be assessed in the ICU. Local management guidelines should be agreed before introducing routine assessment of delirium into clinical practice, in order to promote adherence and ensure appropriate action if delirium is identified. If delirium is detected, the precipitating cause(s) should be addressed. If the patient is agitated or if it is felt that hypoactive delirium is delaying clinical progress, treatment with an antipsychotic should be considered.