[Delirium in the Intensive Care Unit].

Area of Science:

• Critical Care Medicine
• Neuroscience
• Geriatrics

Background:

• Delirium is a frequent complication in Intensive Care Units (ICUs), representing acute cerebral dysfunction.
• It is characterized by fluctuating changes in consciousness and cognition, often associated with underlying physical illness.
• The incidence of delirium in ICUs is notably high, affecting up to 89% of patients.

Purpose of the Study:

• To highlight the prevalence and diagnostic methods for delirium in the ICU.
• To discuss current and emerging therapeutic strategies for delirium management.
• To emphasize the long-term consequences and the gap in active diagnosis by intensivists.

Main Methods:

• Diagnosis relies exclusively on clinical assessment using validated scales like the Confusion Assessment Method for the ICU (CAM-ICU) or Intensive Care Delirium Screening Check-list (ICDSC).
• Application of these scales should be performed at least once per shift by trained healthcare professionals.
• Review of existing and novel therapeutic strategies, including Haloperidol and Dexmedetomidine.

Main Results:

• Delirium diagnosis is primarily clinical, with CAM-ICU and ICDSC being validated tools.
• Newer therapeutic agents like Dexmedetomidine offer safer alternatives to traditional treatments.
• Despite known prevention and treatment strategies, only 33% of intensivists actively screen for delirium.

Conclusions:

• Delirium significantly increases long-term cognitive impairment and mortality risk.
• Subsyndromal Delirium and Delirium Superimposed on Dementia are recognized variations requiring attention.
• There is a critical need to improve the active detection and management of delirium in ICU settings.