Dear Editor,

With great interest, we read Richard’s report of his recovery after 6 weeks on an intensive care unit (ICU) [1]. Most of the time, he had been in coma and delirium. Afterwards, he remembered vivid dreams, such as gunshots, being in different places, being hunted, or sexual abuse. His former partner wrote an ICU diary for him, which helped him to cope with this existential period of his life. He also remembered one nurse who explained to him experiences of nightmares and hallucinations [1]. Someone who talked with him.

Delirium is defined as a cerebral dysfunction [2]. As clinicians in critical care, we are used to treating this organ dysfunction first with a focus on non-pharmacological measures, and, if the organ dysfunction persists, turning to safe pharmacological approaches, to preserve patients’ health. And often, we are standing at the bedside, talking about the patient, possible causes, and discussing pros and cons of treatment options. Who is talking with a patient in delirium? Who is the nurse or clinician explaining these disturbing experiences to the person? Even with disturbed cerebral networks, the personality of patients still exists, and they put their experiences in their own, personal context. From the patient’s view, interaction can be terrifying or soothing, and establishing trust should be as important as other medical procedures [3]. Delirium management has advanced during the last decade [4], and we think that it is time for a next level: humanizing delirium care.

In a highly specialized, technically best equipped environment, humanizing critical care is a multi-dimensional concept, addressing individual persons with own feelings, values, and history. The person is the center of every effort, cared for physical, mental, and spiritual needs, and encouraged to take an active role [5].

Based on a discussion about the meaning of humanizing delirium care during the fourth conference about post intensive care syndrome (PICS) in Madrid, organized by the Itaca-Group, a first approach has been developed (Fig. 1).

Fig. 1
figure 1

How to perform humanizing delirium care

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At the bedside, humanizing delirium care includes:

  • Respect and trust: use patients name and titles, ensure safety

  • Communication skills: personalized (non-)verbal communication techniques with (non-)speaking patients, mirroring, reassuring

  • Empathy: consider patients’ view, experiences

  • Personality: ask and listen for experiences and patient’s story

  • Acceptance: re-orientate and re-frame

  • Accompaniment: hold hand if appropriate, assess symptoms and tolerance

  • Autonomy: offer feasible choices, e.g. sitting in a chair, or being in bed

  • Resilience: ask for personal coping strategies, e.g. information, family, prayers, music

  • Safety: continuous clinicians, explain environment, ensure vision/hearing aids

  • Hope: integrate family, support personal coping

All patients like Richard who are suffering from delirium must have a holistic and humanistic approach. Humanizing delirium care means person-centered delirium-management, with compassionate and empathic clinicians at the bedside. Best care will entail immediate interventions to find reversible causes for ICU delirium and treat them accordingly. Additionally, symptom-orientated patient-centered interventions according to FRAMES (i.e. Feedback, Responsibility, Advice, Menu of behavioral change, Empathy and Self-efficacy) should be implemented. This results in empowerment of relatives and the inter-professional staff to support patients in these dire situations.