Abstract
IntroductionDelirium is a frequent complication in hospitalised patients, often leading to difficulties in patient management and is associated with increased morbidity and mortality. Most patients in intensive care units develop delirium, however, it is also frequently observed in non-intensive care unit settings. Risk factors are, among others, older age, brain pathology, severe trauma, orthopaedic or heart surgery, metabolic or electrolyte dysregulations, infections and polypharmacy. The most important measures to prevent and treat delirium are recognition and removal of risk factors and causes. Although delirium is a very common and serious complication, evidence for pharmacological treatment is poor, and guidelines remain controversial. Accordingly, non-pharmacological treatments have gained increasing attention and should be applied. Based on current literature, guidelines and personal recommendations, we developed a standard operating procedure (SOP) encompassing non-pharmacological and pharmacological treatment of delirium.CommentsIn order to prevent delirium, risk factors should be identified and taken into account when planning the hospital stay and treatment. Prevention should include multimodal non-pharmacological interventions. The treatment of delirium should encompass the elimination of potential causes and non-pharmacological interventions. Pharmacological treatment should be used in a time-limited manner and in the lowest possible dose for the management of highly stressful symptoms or high-risk behaviour.ConclusionThe SOP provides a pragmatic algorithm for the non-pharmacological and pharmacological treatment of delirium.
Highlights
Delirium is a frequent complication in hospitalised patients, often leading to difficulties in patient management and is associated with increased morbidity and mortality
The present standard operating procedure (SOP) for prevention and management of delirium is based on current literature, but the recommendations for pharmacological treatment are based on limited evidence
The evidence for non-pharmacological interventions is more robust for the prevention than for the treatment of delirium [1], the authors of this SOP encourage the use of non-pharmacological interventions (Table 1, Fig. 2) when delirium is present since they will not inflict harm and may at least help individual patients [10, 11]
Summary
Delirium is a frequent complication in hospitalised patients, often leading to difficulties in patient management and is associated with increased morbidity and mortality. The present standard operating procedure (SOP) for prevention and management of delirium is based on current literature, but the recommendations for pharmacological treatment are based on limited evidence. Non-pharmacological prevention and treatment of delirium In order to prevent delirium, avoidance and elimination of causes and risk factors have to be prioritised (Table S2, Fig. 2).
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