Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals.
OBJECTIVE
Recently published clinical practice guidelines of the Society of Critical Care Medicine recommend monitoring for the presence of delirium in all mechanically ventilated patients because of the potential for adverse outcomes associated with this comorbidity, yet little is known about healthcare professionals' opinions regarding intensive care unit delirium or how they manage this organ dysfunction. The aim of this survey was to assess the medical community's beliefs and practices regarding delirium in the intensive care unit.


METHODS
Survey administration was conducted both without a delirium definition (phase 1) and then with a definition of delirium (phase 2).


METHODS
Critical care meetings and continuing medical education/board review courses from October 2001 to July 2002.


METHODS
A convenience sample of physicians (n = 753), nurses (n = 113), pharmacists (n = 13), physician assistants (n = 12), respiratory care practitioners (n = 8), and others (n = 13).


METHODS
Survey.


RESULTS
Participants completed 912 of the surveys. The majority (68%) of respondents thought that >25% of adult mechanically ventilated patients experience delirium. Delirium was considered a significant or very serious problem in the intensive care unit by 92% of healthcare professionals, yet underdiagnosis was acknowledged by 78%. Only 40% reported routinely screening for delirium, and only 16% indicated using a specific tool for delirium assessment. Delirium was considered important in the outcome of elderly and young patients by 89% and 60% of the respondents, respectively (p <.0001). The most serious complications these professionals associated with delirium were prolonged mechanical ventilation, self-injury, and respiratory difficulties. Delirium was treated with haloperidol by 66% of the respondents, with lorazepam by 12%, and with atypical antipsychotics by <5%. More than 55% administered haloperidol and lorazepam at daily doses of < or =10 mg, but some used >50 mg/day of either medication.


CONCLUSIONS
Most healthcare professionals consider delirium in the intensive care unit a common and serious problem, although few actually monitor for this condition and most admit that it is underdiagnosed. Data from this survey point to a disconnect between the perceived significance of delirium in the intensive care unit and current practices of monitoring and treatment.
Ely
E Wesley
EW
Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA. wes.ely@vanderbilt.edu
Stephens
Rasheeda K
RK
Jackson
James C
JC
Thomason
Jason W W
JW
Truman
Brenda
B
Gordon
Sharon
S
Dittus
Robert S
RS
Bernard
Gordon R
GR
D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003422:Critical Care / Q000592:standards* / Q000639:trends; D003693:Delirium / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008297:Male; D011379:Prognosis; D011787:Quality of Health Care; D012121:Respiration, Artificial; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology