Delirium

Abstract

Delirium is a highly prevalent manifestation of acute brain dysfunction in the surgical critically ill patient and is associated with longer hospital stays, higher mortality, and poor cognitive and functional outcomes. The etiology of delirium is not yet fully understood and is probably multifactorial. Addressing modifiable risk factors including sedation management, delirium-associated medications, immobility, and sleep disruption can help to prevent and reduce the duration of delirium. Delirium is classified into three subtypes: hyperactive, hypoactive, and mixed. Although the hyperactive form is readily recognized, the other two forms have been shown to be more common in surgical intensive care unit (SICU) patients. Over the past decade, tools specifically designed for use in critically ill have been developed and validated. Once delirium is recognized and the modifiable risk factors are addressed, the next step in management is a symptom-oriented intervention. The best-studied classes of pharmacological treatments for delirium are the typical and atypical antipsychotics. The first-generation antipsychotics (haloperidol) as well as the second-generation antipsychotics (olanzapine, quetiapine, and risperidone) all appear to be equally effective treatments for established delirium. For agitation, alpha-2 agonists or propofol can be used. It is essential for patient care that strategies to prevent, diagnose, and treat postoperative delirium should be prioritized by all practitioners in the perioperative period.