Delirium in Cardiac Intensive Care Unit

Abstract

Delirium is a multifactorial syndrome and is described as an acute brain dysfunction seen commonly in post-cardiac surgery patients. The prevalence of post-operative Delirium (POD) ranges from 11.4% to 55%, depending on the diagnostic tool and type of study. Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the two most used and recommended tools by the Society of Intensive Care Medicine. Annual delirium-related healthcare costs in the United States (US) range from 6.6 to 20.4 billion USD in ICU patients. However, delirium in cardiac ICU (CICU) is underdiagnosed and warrants vigorous workup. The risk factors for delirium in CICU can be classified as modifiable, non-modifiable, and cardiac surgical causes. After cardiac procedures, delirium is associated with increased mortality, increased length of hospital stay, loss of functional independence, increased hospital costs, and an independent predictor of death 10 years postoperatively. Non-pharmacological measures such as avoiding delirium-risk medications, early physical rehabilitation, occupational therapy, and sleep improvement strategies have shown significant benefits in decreasing delirium. Pharmacological options are limited for use in CICU, and a need for future studies in this topic is in demand.