ICU delirium Diagnosis and management Indications for screening Monitor critically ill adult patients regularly for delirium. E General principles Q Does the patient have delirium? No Continue management and follow-up as clinically appropriate. Yes Use a multidisciplinary approach to facilitate the management of delirium in critically ill adult patients, including preprinted and/or computerized protocols and order forms, quality ICU rounds checklists, and provider education. B Pharmacologic therapy Consider not using haloperidol or an atypical antipsychotic to treat subsyndromal delirium in critically ill adults. D Consider not routinely using haloperidol, an atypical antipsychotic, or a statin to treat delirium in critically ill adults. D Consider using dexmedetomidine for delirium in mechanically ventilated adults where agitation is precluding weaning/extubation. C Management of sedation Q Is the patient mechanically ventilated? Yes Consider using light sedation rather than deep sedation in critically ill, mechanically ventilated adults. C Consider using either propofol or dexmedetomidine over benzodiazepines for sedation in critically ill, mechanically ventilated adults. C No Management of sleep disturbance Q Does the patient have disturbed sleep? Yes Consider using noise and light reduction strategies to improve sleep in critically ill adults. C Consider using assist-control ventilation at night (vs. pressure support ventilation) for improving sleep in critically ill adults. C Insufficient evidence to recommend melatonin to improve sleep in critically ill adults. I Avoid routine use of physiologic sleep monitoring clinically in critically ill adults. D No Early mobilization Q Can the patient be mobilized safely? Yes Mobilize adult ICU patients as soon as safe and feasible, to reduce the incidence and duration of delirium. B No Continue management and follow-up as clinically appropriate.