Prevalence and Screening
Delirium in ICU is very common with estimates ranging from 16 – 89%.
It can be screened for with the CAM-ICU tool if altered mental state present:
Treatment of Delirium
The treatment of delirium involves a multi-faceted approach.
Non-pharmacological methods should be used first – these include orientation and environmental strategies as well as looking for and treating any cause (this includes reviewing their medication chart).
Pharmacological and physical restraints may be indicated if patient is at danger from themselves or to others. If needing pharmacological measures regular quetiapine is often used – often starting at 12.5mg or 25mg bd. There is some limited evidence that this can lead to earlier hospital discharge. Other drugs used in acute behavioural emergencies are discussed in more detail in the sedation section.
References and Further Reading
NEJM Review article: Sedation and Delirium in ICU
Critical Care Journal: Delirium in the Intensive Care Unit
NSW Delirium in ICU Guidelines
Author: George Walker