Delirium

Question 1

What is delirium?

Answer 1

Disturbance of consciousness with a change in cognition that develops over a short time period and has a fluctuating course.

Question 2

How can delirium be classified?

Answer 2

Hyperactive
Hypoactive
Mixed

Question 3

What are the risk factors for ICU delirium?

Answer 3

Patient factors:

• age
• depression
• prior cognitive impairment
• alcoholism
• hypertension
• smoking
• prior sensory impairment

Illness factors:

• anaemia
• acidosis
• metabolic disturbances
• sepsis
• illness severity

Iatrogenic/environmental:

• sleep disturbance
• pain
• medication (anticholinergics and sedatives)

Question 4

How might you assess for delirium in the ICU?

Answer 4

CAM-ICU assessment:

1. Acute onset or fluctuating course (Y/N)
2. Inattention (errors >2)
3. Altered level of consciousness (e.g. RASS anything other than zero)
4. Disorganised thinking (errors >1)

1+2 & 3 or 4 = CAM-ICU positive

Question 5

Why is delirium important?

Answer 5

Associated with increased:

• mortality
• ventilator days
• ICU length of stay
• long term cognitive impairment

Question 6

How is delirium managed?

Answer 6

Prevention is key:
ABCDE
Awake and Breathing - sedation hold, sleep hygiene
Coordination and Choice of sedation - minimise sensory impairment, DahLIA and Midex-Prodex trial in favour of Dexmed.
Delirium monitoring - CAM ICU
Early mobilisation, Ease of pain