Related Experiment Video
Updated: Jan 3, 2026
Use of a Central Venous Line for Fluids, Drugs and Nutrient Administration in a Mouse Model of Critical Illness
Published on: May 2, 2017
Delirium in the critically ill patient
Nathan E Brummel1, Timothy D Girard2
1Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
Insights
Delirium, a brain dysfunction affecting ICU patients, is harmful but often missed. Using screening tools and non-benzodiazepine sedation, like the ABCDEF bundle, effectively reduces delirium incidence and severity.
Area of Science:
- Critical Care Medicine
- Neuroscience
- Geriatrics
Background:
- Delirium is an acute brain dysfunction impacting consciousness, affecting up to 50% of intensive care unit (ICU) admissions.
- Previously underestimated, delirium is now recognized as detrimental to both short-term and long-term patient outcomes.
- Despite its high prevalence in critically ill patients, delirium frequently remains undiagnosed.
Purpose of the Study:
- To highlight the importance of recognizing and managing delirium in the ICU.
- To discuss modifiable risk factors and effective management strategies for delirium.
- To evaluate current treatment approaches, including pharmacologic and non-pharmacologic interventions.
Main Methods:
- Utilizing validated delirium screening tools for reliable detection in the ICU setting.
- Identifying and addressing modifiable risk factors, such as benzodiazepine use.
- Implementing non-pharmacologic strategies to mitigate sensory impairment, sleep deprivation, and immobility.
- Evaluating the efficacy of sedation strategies, favoring non-benzodiazepine-based approaches.
- Assessing the evidence for pharmacologic treatments, including antipsychotics and the "ABCDEF bundle".
Main Results:
- Benzodiazepines are identified as a dose-dependent risk factor for delirium.
- Non-benzodiazepine sedation strategies and non-pharmacologic interventions are effective in reducing delirium.
- Antipsychotics, while commonly used, lack support from placebo-controlled trials for delirium treatment.
- The "ABCDEF bundle" has demonstrated efficacy in multiple trials for delirium reduction.
Conclusions:
- Early and accurate detection of delirium using screening tools is crucial in the ICU.
- Modifying risk factors, particularly reducing benzodiazepine exposure and optimizing sedation, is key.
- Non-pharmacologic interventions and evidence-based bundles like "ABCDEF" are recommended for delirium management.
- Further research should focus on optimizing patient care to prevent and treat delirium effectively.
Abstract:
Delirium is an acute and transient brain dysfunction that is characterized by disturbances in consciousness, affecting both its content (i.e., attention) and level (i.e., arousal). It affects as many as 50% of those admitted to an intensive care unit (ICU). Once believed to be an inconsequential outcome of critical illness, it is now recognized that delirium is harmful in both the short- and long-term. Despite occurring frequently in critically ill patients, delirium often goes unrecognized. Well-validated delirium screening tools, designed for use in the ICU, should be used to reliably detect delirium. The first step in delirium treatment is to identify and address potentially modifiable risk factors. Multiple trials have shown that benzodiazepines are a risk factor for delirium in a dose-dependent manner. Sedation with nonbenzodiazepine-based strategies are an effective means by which to reduce delirium. Nonpharmacologic strategies such as those which seek to reduce sensory impairment, sleep deprivation, and immobility are effective. Pharmacologic treatment with antipsychotics, though commonly used, is not supported by findings from placebo-controlled trials. Recent data support from multiple trials support the use of the "ABCDEF bundle" as a means by which to reduce delirium.
More Related Videos
Related Concept Videos
01:23Acute Respiratory Failure-IV
01:30Acute Respiratory Failure-III
01:26Psychosis: Goals of Pharmacotherapy
01:15Drug Dosing: Geriatric Patients
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:29Pneumonia II: Pathophysiology