Delirium: acute cognitive dysfunction in the critically ill.
OBJECTIVE
The management of sepsis and the multiple organ dysfunction syndrome has traditionally been centered on dysfunction of organs other than the brain (e.g., heart, lungs, or kidneys), although the brain is one of the most prevalent organs involved. Recent studies indicate that nonpulmonary acute organ dysfunction may contribute significantly to mortality and other important clinical outcomes. Acute confusional states (delirium) occur in 10 to 60% of the older hospitalized population and in 60 to 80% of patients in the intensive care unit, yet go unrecognized by the managing physicians and nurses in 32 to 66% of cases. Delirium is an important independent prognostic determinant of hospital outcomes, including duration of mechanical ventilation, nursing home placement, functional decline, and death. Recently, new monitoring instruments have been validated for monitoring of delirium in noncommunicative patients receiving mechanical ventilation. Hence, critical care physicians and nurses should routinely assess their patients for delirium and develop strategies for its prevention and treatment.


RESULTS
This state-of-the-art review discusses in depth the delirium monitoring instruments, the pathophysiology and risk factors of delirium, its prognostic implications, and strategies (including ongoing clinical trials) to prevent and treat delirium.


CONCLUSIONS
Delirium is extremely common and has significant prognostic implications in critically ill patients. Routine monitoring and a multimodal approach to prevent or reduce the prevalence of delirium are of paramount importance.
Pandharipande
Pratik
P
Department of Anesthesiology/Division of Critical Care, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. pratik.pandharipande@vanderbilt.edu
Jackson
James
J
Ely
E Wesley
EW
D000368:Aged; D000698:Analgesia / Q000379:methods; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis / Q000191:economics / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D016292:Procedural Sedation / Q000379:methods; D017281:Cost of Illness; D003422:Critical Care / Q000191:economics / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D003693:Delirium / Q000175:diagnosis / Q000191:economics / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D005853:Geriatrics / Q000379:methods; D006801:Humans; D011379:Prognosis; D012307:Risk Factors
D014150:Antipsychotic Agents