Sedative Agents and Prophylaxis in ICU Delirium

Abstract

Delirium is a form of acute brain dysfunction in the critically ill that is associated with significant morbidity and mortality in addition to increases in healthcare costs. Important risk factors for delirium include a patient’s underlying illness, metabolic disturbances, sedative and psychoactive medications, and underlying cognitive impairment. Vigilant monitoring and recognition are the first step in reducing the burden of delirium. The Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (IDCSC) are the validated methods of diagnosing delirium in the intensive care unit. Definitive evidence of treatments to reduce the incidence or duration of delirium in the intensive care unit is limited. Protocolized care to ensure minimization of sedation and appropriate sedative selection, early ventilator liberation, adequate treatment of pain, early mobility, and proper sleep hygiene offer the best hope of reducing the incidence of delirium and its burden on healthcare and society.