Deliriummanagement

DeliriumManagement refers to the clinical approach to delirium, a transient disturbance in attention and awareness characterized by acute onset and fluctuations in cognition. The goal is to identify and treat underlying causes, minimize risk factors, and reduce duration and severity of delirium to improve outcomes for patients, particularly older adults and those in intensive care.

Assessment and diagnosis: Delirium should be screened routinely in high-risk settings using validated tools such as the Confusion Assessment Method (CAM) in general wards or CAM-ICU in the ICU. A comprehensive evaluation includes medical history, physical examination, laboratory testing, and review of medications to identify precipitating factors like infections, metabolic disturbances, hypoxia, dehydration, pain, sleep deprivation, polypharmacy, and withdrawal.

Nonpharmacologic management: Core strategy emphasizes prevention and supportive care. Interventions include reorientation (clocks, calendars, presence of family), regular sleep-wake cycles, early mobility, hydration and nutrition, pain control, hearing and vision support, minimizing sensory deprivation, and avoiding delirium-inducing drugs when possible. Multidisciplinary teams and environmental modifications improve outcomes.

Pharmacologic management: Pharmacotherapy is reserved for severe agitation, psychosis, or safety concerns after addressing underlying causes. Short-acting antipsychotics such as haloperidol or second-generation agents like quetiapine may be used with caution, monitoring for extrapyramidal symptoms and QT prolongation. Benzodiazepines are generally avoided except in alcohol or benzodiazepine withdrawal. Regular medication reconciliation and deprescribing of inappropriate drugs is recommended.

Outcomes and prevention: Delirium is associated with longer hospital stays, higher mortality, and long-term cognitive impairment. Prevention programs, especially in older adults and ICU patients, focus on risk factor modification and nonpharmacologic care; evidence supports multifactorial approaches.