Intensive care unit psychosis revisited: understanding and managing delirium in the critical care setting

Delirium occurs frequently in critically ill patients, yet this syndrome is often unrecognized and poorly understood. Health professionals must recognize delirium and patients at risk because delirium can lead to higher morbidity rates and longer lengths of stay. Various disease states and pathophysiologic disorders cause delirium, as do many commonly used drugs. Other factors, such as age and sleep deprivation, contribute or predispose patients to its development. The clinical presentation of delirium is varied, and delirious patients can have increased or decreased psychomotor activity, impaired attentional and memory systems, disorganized thinking, and hallucinations or delusions. Treatment of delirium focuses on finding the cause and managing the symptoms, often with the use of pharmacologic agents. Critical care nurses need to perform cognitive assessments so that deficits can be recognized and specific interventions for prevention of cognitive impairment can be used. Appropriate nursing care can lessen the severity of delirium, shorten its course, and decrease the morbidity associated with the syndrome.