More questions than answers in ICU delirium: pressing issues for future research

With the release of the updated pain, agitation, and delirium guidelines by the Society of Critical Care Medicine, a number of new and updated recommendations are provided regarding the pharmacological prevention and treatment of ICU delirium. Whereas this is important to understand the limitations of existing literature in interpreting the guideline recommendations, it also provides an opportunity to identify those areas of practice where we need further knowledge. We discuss 5 of the most critical questions in our view regarding pharmacological therapy for ICU delirium in an attempt to highlight areas of this ICU condition that are much deserving of further research, including the deliriogenic potential of dexmedetomidine, optimal sedative choices for the delirious ICU patient, pharmacological prophylaxis for ICU delirium, optimal treatment duration for ICU delirium, and the impact of pharmacotherapy on long-term cognitive outcomes in ICU survivors. A multitude of opportunities for further research exist in the above areas for clinicians and researchers interested in this ICU condition.