Assessment and Management of Delirium Across the Life Span

Evidence Update10/1/2018

Practice Alert

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Scope and Impact of the Problem

Delirium is an acute change in consciousness that is accompanied by inattention and either a change in cognition or perceptual disturbance.1 Patients can have hyperactive delirium (agitation, restlessness, attempting to remove catheters, and/or emotional lability), hypo-active delirium (flat affect, withdrawal, apathy, lethargy, and/or decreased responsiveness), or a combination of both.1 Delirium affects up to 80% of patients in the intensive care unit (ICU), and it is estimated that ICU costs associated with delirium equal between $4 billion and $16 billion annually in the United States.2-6

This form of acute brain dysfunction is associated with increased length of ICU and hospital stays, time receiving mechanical ventilation, mortality, and long-term cognitive impairment.7-9 Despite this high prevalence and the adverse outcomes, delirium in the ICU goes undetected and, thus, untreated in scores of patients.10 Iatrogenic risk factors are often modifiable and are referred to as precipitating factors.3,11

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