DelirManagement

Delirmanagement is the systematic approach to the recognition, prevention, and treatment of delirium, a sudden, fluctuating disturbance in attention and cognition that occurs in the context of an acute medical illness, surgery, or withdrawal. Delirium is common in older adults and in critical care, and is associated with longer hospital stays, higher mortality, and potential long-term cognitive impairment.

Common etiologies and risk factors include infection, hypoxia, metabolic disturbances, medications with anticholinergic or sedative effects, alcohol or sedative withdrawal, dehydration, pain, and sleep disruption; risk increases with age, pre-existing dementia, sensory impairment, and polypharmacy.

Assessment relies on validated tools such as the Confusion Assessment Method (CAM) and CAM-ICU or the Intensive Care Delirium Screening Checklist (ICDSC). Regular delirium screening is recommended in hospital and ICU settings.

Management principles center on identifying and treating the underlying cause, ensuring safety, rehydration and pain control, maintaining nutrition and sleep, and minimizing delirium-promoting factors. Nonpharmacologic strategies include early mobilization, orientation cues, adequate lighting and sleep hygiene, hearing and vision optimization, hydration, and family engagement.

Avoid or minimize deliriogenic medications when possible; review analgesia and sedatives to use the lightest effective regimen.

Pharmacologic treatment is reserved for severe agitation or distress and is typically a low-dose antipsychotic such as haloperidol or second-generation agents, with caution and monitoring. Benzodiazepines are generally avoided except for alcohol or benzodiazepine withdrawal.

Prevention programs and bundles (for example, ABCDEF) integrate pain control, spontaneous awakening and breathing trials, appropriate sedation, delirium monitoring, mobility, and family involvement.