Delirium in burn patients: Incidence, risk factors, and management strategies

Delirium is an acute, fluctuating disturbance of attention, awareness, and cognition. Delirium is common and multifactorial in pediatric and adult burn patients. Delirium can be hyperactive, hypoactive, or mixed in phenotype. This is an important complication associated with prolonged hospitalization, increased morbidity and mortality, and possibly long term cognitive and psychological sequelae, highlighting the importance of prevention and early recognition. Burn patients are particularly vulnerable due to the combination of the intense systemic inflammatory response, disruption of the blood brain barrier, neuroinflammation, neurotransmitter imbalances, and impaired cerebral energy metabolism involved, not to mention the frequent painful procedures, heavy sedation and analgesia requirements, and inherent risks of critical illness and ICU admission themselves. This review summarizes the epidemiology, risk factors, diagnostic challenges, management, and prevention of delirium in burn patients, highlighting issues specific to this population.