Delirium is defined in the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a disturbance of consciousness and cognition that develops over a short period of time (hours to days) and fluctuates over time.1 Many different terms have been used to describe the syndrome of cognitive impairment in critically ill patients, including ICU psychosis, acute confusional state, ICU encephalopathy, and acute brain syndrome; however, ICU delirium is the preferred term. Delirium is a very common and serious complication in ICU patients.2–5 McNicoll et al.6 reported that 70.3% of elderly ICU patients developed delirium at some time during their hospitalization. Delirium in ICU patients has been demonstrated to be an independent predictor of the length of hospital stay as well as ICU and 6-month mortality rates.2–5,7,8 In addition, delirium may be a predictor of long-term cognitive impairment in survivors of critical illness.


Postoperative Delirium Wake Cycle Bright Light Therapy Acute Confusional State Delirium Assessment 


  1. 1.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC: American Psychiatric Association; 2000.Google Scholar
  2. 2.
    Gunther ML, Jackson JC, Ely EW. The cognitive consequences of critical illness: practical recommendations for screening and assessment. Crit Care Clin. 2007;23:491–506.PubMedCrossRefGoogle Scholar
  3. 3.
    Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care. 2008;12(Suppl 3):S3.PubMedCrossRefGoogle Scholar
  4. 4.
    Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291:1753–1762.PubMedCrossRefGoogle Scholar
  5. 5.
    Pandharipande P, Cotton BA, Shintani A, et al. Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients. J Trauma. 2008;65:34–41.PubMedCrossRefGoogle Scholar
  6. 6.
    McNicoll L, Pisani MA, Zhang Y, et al. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc. 2003;51:591–598.PubMedCrossRefGoogle Scholar
  7. 7.
    Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001;27:1892–1900.PubMedCrossRefGoogle Scholar
  8. 8.
    Lin SM, Liu CY, Wang CH, et al. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med. 2004;32:2254–2259.PubMedCrossRefGoogle Scholar
  9. 9.
    Peterson JF, Pun BT, Dittus RS, et al. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc. 2006;54:479–484.PubMedCrossRefGoogle Scholar
  10. 10.
    Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996;275:852–857.PubMedCrossRefGoogle Scholar
  11. 11.
    Cooper AB, Thornley KS, Young GB, et al. Sleep in critically ill patients requiring mechanical ventilation. Chest. 2000;117:809–818.PubMedCrossRefGoogle Scholar
  12. 12.
    Pandharipande P, Shintani A, Peterson J, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiol. 2006;104:21–26.CrossRefGoogle Scholar
  13. 13.
    Marcantonio ER, Juarez G, Goldman L, et al. The relationship of postoperative delirium with psychoactive medications. JAMA. 1994;272:1518–1522.PubMedCrossRefGoogle Scholar
  14. 14.
    Parikh SS, Chung F. Postoperative delirium in the elderly. Anesth Analg. 1995;80:1223–1232.PubMedGoogle Scholar
  15. 15.
    Kaneko T, Takahashi S, Naka T, et al. Postoperative delirium following gastrointestinal surgery in elderly patients. Surg Today. 1997;27:107–111.PubMedCrossRefGoogle Scholar
  16. 16.
    Santos FS, Velasco IT, Fraguas R Jr. Risk factors for delirium in the elderly after coronary artery bypass graft surgery. Int Psychogeriatr. 2004;16:175–193.PubMedCrossRefGoogle Scholar
  17. 17.
    Zakriya K, Sieber FE, Christmas C, et al. Brief postoperative delirium in hip fracture patients affects functional outcome at three months. Anesth Analg. 98:1798–1802.Google Scholar
  18. 18.
    Marcantonio ER, Flacker JM, Michaels M, et al. Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc. 2000;48:618–624.PubMedGoogle Scholar
  19. 19.
    Gustafson Y, Berggren D, Brannstrom B, et al. Acute confusional states in elderly patients treated for femoral neck fracture. J Am Geriatr Soc. 1988;36:525–530.PubMedGoogle Scholar
  20. 20.
    Marcantonio ER, Flacker JM, Wright RJ, et al. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49:516–522.PubMedCrossRefGoogle Scholar
  21. 21.
    Olofsson B, Lundstrom M, Borssen B, et al. Delirium is associated with poor rehabilitation outcome in elderly patients treated for femoral neck fractures. Scand J Care Sci. 2005;19:119–127.CrossRefGoogle Scholar
  22. 22.
    Armstrong SC, Cozza KL, Watanabe KS. The misdiagnosis of delirium. Psychosomatics. 1997;38:433–439.PubMedCrossRefGoogle Scholar
  23. 23.
    Devlin JW, Fong JJ, Fraser GL, et al. Delirium assessment in the critically ill. Intensive Care Med. 2007;33:929–940.PubMedCrossRefGoogle Scholar
  24. 24.
    Bergeron N, Dubois MJ, Dumont M, et al. Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27:859–864.PubMedCrossRefGoogle Scholar
  25. 25.
    Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286:2703–2710.PubMedCrossRefGoogle Scholar
  26. 26.
    Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340:669–676.PubMedCrossRefGoogle Scholar
  27. 27.
    Vaurio LE, Sands LP, Wang Y, et al. Postoperative delirium: the importance of pain and pain management. Anesth Analg. 2006;102:1267–1273.PubMedCrossRefGoogle Scholar
  28. 28.
    Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30:119–141.PubMedCrossRefGoogle Scholar
  29. 29.
    Practice guideline for the treatment of patients with delirium. American Psychiatric Association. Am J Psychiatry. 1999;156:1–20.Google Scholar
  30. 30.
    Milbrandt EB, Kersten A, Kong L, et al. Haloperidol use is associated with lower hospital mortality in mechanically ventilated patients. Crit Care Med. 2005;33:226–229.PubMedCrossRefGoogle Scholar
  31. 31.
    Kaneko T, Cai J, Ishikura T, et al. Prophylactic consecutive administration of haloperidol can reduce the occurrence of postoperative delirium in gastrointestinal surgery. Yonaga Acta Medica 1999;42:179–184.Google Scholar
  32. 32.
    Skrobik YK, Bergeron N, Dumont M, et al. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med. 2004;30:444–449.PubMedCrossRefGoogle Scholar
  33. 33.
    Han CS, Kim YK. A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics. 2004;45:297–301.PubMedCrossRefGoogle Scholar
  34. 34.
    Reade MC, O'Sullivan K, Bates S, et al. Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Crit Care. 2009;13:R75.PubMedCrossRefGoogle Scholar
  35. 35.
    Hanania M, Kitain E. Melatonin for treatment and prevention of postoperative delirium. Anesth Analg. 2002;94:338–339.PubMedGoogle Scholar
  36. 36.
    Bourne RS, Mills GH, Minelli C. Melatonin therapy to improve nocturnal sleep in critically ill patients: encouraging results from a small randomised controlled trial. Crit Care. 2008;12:R52-doi:10.1186/cc6871.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineEastern Virginia Medical SchoolNorfolkUSA

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