Risk Factors, Pathophysiology, and Management of ICU Delirium: A Literature Review

Abstract

Background: Delirium is an acute change in mental status with an unpredictable course of diminished attention and incoherent thinking, which is common among ICU patients. Various evidence implies a correlation between delirium and many fatal outcomes in intensive care unit (ICU) patients, such as higher 6-month mortality rate, longer hospital stays, longer post-ICU hospital stays, a higher occurrence of cognitive impairment, and long-term cognitive impairment after a critical illness. Aim: To identify the risk factors, pathophysiology, and management of ICU delirium among critically ill patients. Method: Using literature review, this study thoroughly examined the results of studies from different journals investigating ICU delirium Findings: The identified risk factors were age, cigarette smoking, alcohol abuse, eroids, sedatives, total number of medications, sodium level, hypoalbuminemia, hypertension, sepsis, chronic renal failure, trauma, immobility, and pain. Moreover, underlying mechanisms in the development of ICU delirium were cholinergic deficiency, neuropathologic lesion, direct brain insults, aberrant stress response and inflammatory process, and alteration of plasma melatonin. Numerous effective non-pharmacologic and pharmacologic treatments are available to manage delirium. Conclusion: Delirium is a form of acute brain dysfunction that is not well-recognized in ICU. The identification of the risk factors and the possible underlying mechanisms for the development of delirium continues to be the first step in its management; then, the next step is often pharmacologic and non-pharmacologic treatments. The choice of these treatments should be understood as part of a greater multicomponent approach in the management of critically ill patients.