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Delirium Management in the ICU

  • Michael E. ReznikEmail author
  • Arjen J. C. Slooter
Critical Care Neurology (H Hinson, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Critical Care Neurology

Abstract

Purpose of review

Delirium occurs frequently in critically ill patients and is associated with adverse outcomes in both the short and long term. In this review, we aim to highlight recent study findings on the prevention and treatment of delirium, provide additional recommendations based on expert guidelines, and indicate knowledge gaps deserving of future study.

Recent findings

Multicomponent non-pharmacologic interventions have been shown to be efficacious in non-ICU populations, and multicomponent strategies such as the ABCDEF bundle have been adopted in the ICU with several studies showing a potential benefit in delirium outcomes. Meanwhile, two negative randomized clinical trials of antipsychotics in ICU patients (REDUCE and MIND-USA) have provided strong evidence that such medications neither prevent nor shorten the duration of delirium. Other potential pharmacologic treatments with promising results include dexmedetomidine and, to a lesser extent, ramelteon, but more data is needed before they may be more definitively recommended.

Summary

Effective and proven delirium management strategies are still largely lacking, though there is evidence to support the use of some non-pharmacologic interventions. Future studies of novel non-pharmacologic interventions and pharmacologic agents other than antipsychotics are warranted.

Keywords

ICU delirium Delirium management 

Notes

Compliance with Ethical Standards

Conflict of Interest

Michael E. Reznik declares no potential conflicts of interest.

Arjen J.C. Slooter reports grants and non-financial support from Prolira, a start-up company that develops an EEG-based delirium monitor. Dr. Slooter is an advisor for Prolira. Any (future) profits from EEG-based delirium monitoring will be used for future scientific research only. In addition, Dr. Slooter has a patent “Method and system for determining a parameter which is indicative for whether a patient is delirious” (application no.: PCT/EP2013/069521, Filed September 19, 2013); pending.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Departments of Neurology & Neurosurgery, Alpert Medical SchoolBrown UniversityProvidenceUSA
  2. 2.Division of Neurocritical CareRhode Island HospitalProvidenceUSA
  3. 3.Department of Intensive Care Medicine, University Medical Center Utrecht Brain CenterUtrecht UniversityUtrechtthe Netherlands

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