Intensive Care Medicine

, 34:1907 | Cite as

Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients

  • A. Morandi
  • P. Pandharipande
  • M. Trabucchi
  • R. Rozzini
  • G. Mistraletti
  • A. C. Trompeo
  • C. Gregoretti
  • L. Gattinoni
  • M. V. Ranieri
  • L. Brochard
  • D. Annane
  • C. Putensen
  • U. Guenther
  • P. Fuentes
  • E. Tobar
  • A. R. Anzueto
  • A. Esteban
  • Y. Skrobik
  • J. I. F. Salluh
  • M. Soares
  • C. Granja
  • A. Stubhaug
  • S. E. de Rooij
  • E. Wesley Ely
Clinical Commentary



Delirium (acute brain dysfunction) is a potentially life threatening disturbance in brain function that frequently occurs in critically ill patients. While this area of brain dysfunction in critical care is rapidly advancing, striking limitations in use of terminology related to delirium internationally are hindering cross-talk and collaborative research. In the English literature, synonyms of delirium such as the Intensive Care Unit syndrome, acute brain dysfunction, acute brain failure, psychosis, confusion, and encephalopathy are widely used. This often leads to scientific "confusion" regarding published data and methodology within studies, which is further exacerbated by organizational, cultural and language barriers.


We undertook this multinational effort to identify conflicts in terminology and phenomenology of delirium to facilitate communication across medical disciplines and languages.


The evaluation of the terminology used for acute brain dysfunction was determined conducting communications with 24 authors from academic communities throughout countries/regions that speak the 13 variants of the Romanic languages included into this manuscript.


In the 13 languages utilizing Romanic characters, included in this report, we identified the following terms used to define major types of acute brain dysfunction: coma, delirium, delirio, delirium tremens, délire, confusion mentale, delir, delier, Durchgangs-Syndrom, acute verwardheid, intensiv-psykose, IVA-psykos, IVA-syndrom, akutt konfusion/forvirring. Interestingly two terms are very consistent: 100 % of the selected languages use the term coma or koma to describe patients unresponsive to verbal and/or physical stimuli, and 100% use delirium tremens to define delirium due to alcohol withdrawal. Conversely, only 54% use the term delirium to indicate the disorder as defined by the DSM-IV as an acute change in mental status, inattention, disorganized thinking and altered level of consciousness.


Attempts towards standardization in terminology, or at least awareness of differences across languages and specialties, will help cross-talk among clinicians and researchers.


Delirium Delirio Delire Delier Delir Délire Confusion Confusione Coma Acute brain dysfunction Psychosis Delirium tremens Durchgangs-Syndrom Acute verwardheid 



We would like to thank Mrs. Patricia Lee, the medical librarian who conducted the literature search by which we generated the Figure 1, Dr. Ayumi Shintani PhD, the biostatistician who performed the P-value calculation, and Mr. Tim Peck, the graphic designer who generated the Figure 3 describing the delineation between coma and delirium.

Conflict of interest statement

None of the authors have any potential conflicts of interest as related to the content of this manuscript.


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • A. Morandi
    • 1
    • 2
    • 3
  • P. Pandharipande
    • 4
  • M. Trabucchi
    • 3
  • R. Rozzini
    • 2
    • 3
  • G. Mistraletti
    • 5
  • A. C. Trompeo
    • 6
  • C. Gregoretti
    • 7
  • L. Gattinoni
    • 8
  • M. V. Ranieri
    • 6
  • L. Brochard
    • 9
  • D. Annane
    • 10
  • C. Putensen
    • 11
  • U. Guenther
    • 11
  • P. Fuentes
    • 12
  • E. Tobar
    • 13
  • A. R. Anzueto
    • 14
  • A. Esteban
    • 15
  • Y. Skrobik
    • 16
  • J. I. F. Salluh
    • 17
  • M. Soares
    • 17
  • C. Granja
    • 18
  • A. Stubhaug
    • 19
  • S. E. de Rooij
    • 20
  • E. Wesley Ely
    • 1
    • 21
    • 22
  1. 1.Center for Health Services ResearchNashvilleUSA
  2. 2.Department of Internal Medicine and GeriatricsPoliambulanza HospitalBresciaItaly
  3. 3.Geriatric Research GroupBresciaItaly
  4. 4.Division of Critical Care Medicine, Department of AnesthesiologyVanderbilt Medical CenterNashvilleUSA
  5. 5.Istituto di Anestesiologia e RianimazioneUniversità degli Studi di Milano, U.O. di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo, Polo UniversitarioMilanItaly
  6. 6.Intensive Care UnitMolinette Hospital, Universita’ di TorinoTorinoItaly
  7. 7.Intensive Care UnitAzienda Ospedaliera CTO-CRF-ICORMATorinoItaly
  8. 8.Istituto di Anestesiologia e RianimazioneUniversità degli Studi di Milano, U.O. di Anestesia e Rianimazione, Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena di MilanoMilanItaly
  9. 9.Réanimation Médicale, AP-HP, centre hospitalier Albert Chenevier, Henri MondorCréteilFrance
  10. 10.Service de réanimation, hôpital Raymond Poincaré (AP-HP)Université de VersaillesGarchesFrance
  11. 11.Department of Anesthesiology and Intensive Care MedicineUniversity Hospital Sigmund FreudBonnGermany
  12. 12.Geriatrics Section, Medicine DepartmentClinical Hospital University of ChileSantiagoChile
  13. 13.Medicina IntensivaHospital Clínico Universidad de ChileSantiagoChile
  14. 14.South Texas Veterans Health Care System, Audie L. Murphy DivisionThe University of Texas Health Science Center at San AntonioSan AntonioUSA
  15. 15.Intensive Care UnitHospital Universitario de Getafe, CIBER de Enfermedades RespiratoriasMadridSpain
  16. 16.Intensive Care UnitUniversité de Montréal, Hospital Maisonnevue-RosemontMontrealCanada
  17. 17.Intensive Care Unit, Centro de Tratamento IntensivoInstituto Nacional de Câncer, INCARio de JaneiroBrazil
  18. 18.Medical Intensive Care UnitHospital Pedro HispanoMatosinhosPortugal
  19. 19.Department of Anesthesiology and Intensive CareRikshopitalet University HospitalOsloNorway
  20. 20.Department of Geriatrics, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  21. 21.VA Tennessee Valley Geriatric ResearchEducation and Clinical Center (GRECC)NashvilleUSA
  22. 22.Division of Allergy/Pulmonary/Critical Care MedicineVanderbilt Medical CenterNashvilleUSA

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