[Delusion in the critical patient]

Area of Science:

• Critical Care Medicine
• Neurology
• Geriatrics

Background:

• Delirium, or acute confusional syndrome, is frequently underdiagnosed in critically ill patients, especially the hypoactive subtype.
• Risk factors include prior cognitive issues, comorbidities, environmental factors, and acute illness-related organic changes.
• Delirium is linked to increased mortality, prolonged mechanical ventilation, extended ICU and hospital stays, and post-discharge cognitive deficits.

Purpose of the Study:

• To review the current understanding of delirium in critically ill patients.
• To highlight validated tools for delirium detection in the ICU.
• To discuss current management strategies, including risk factor modification and pharmacological treatment.

Main Methods:

• Literature review focusing on delirium in critically ill patients.
• Evaluation of diagnostic tools such as the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method for ICU patients (CAM-ICU).
• Analysis of treatment approaches, including non-pharmacological interventions and first-line pharmacological agents like haloperidol.

Main Results:

• Validated tools (ICDSC, CAM-ICU) are effective for delirium detection, even in mechanically ventilated patients.
• Interventions targeting specific risk factors can reduce delirium incidence.
• Haloperidol is the primary pharmacological treatment; use of atypical neuroleptics is limited.
• Management involves addressing contributing factors, supportive care, and symptomatic treatment, potentially including benzodiazepines, propofol, or physical restraints for severe agitation.

Conclusions:

• Delirium is a significant complication in critical care with serious short- and long-term consequences.
• Early and accurate detection using validated screening tools is essential.
• Comprehensive management, including risk factor modification and appropriate pharmacological and non-pharmacological interventions, is key to improving patient outcomes.