Assessment and Management of Delirium Across the Life Span

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