Guideline sources The following summarized guidelines for the evaluation and management of ICU delirium are prepared by our editorial team based on guidelines from the Society of Critical Care Medicine (SCCM 2022; 2018; 2013). 1 2 4 Calculator Calculator Pathway AWOL score for delirium Confusion assessment method ICU deliriu Diagnosis a Guidelines 1. Screening and diagnosis Indications for screening: monitor critically ill adult patients regularly for delirium. E Risk factors: Preexisting dementia, history of hypertension and/or alcoholism, and a high severity of illness at admission are strongly associated with the development of delirium in the ICU. B https://web.pathway.md/diseases/reccEXtBzUpU4rERP 1/3 6/24/23, 2:27 PM ICU delirium Pathway Benzodiazepine use may be a risk factor for the development of delirium in adult ICU patients. B 2. Classification and risk stratification Risk stratification: Predictive models that include delirium risk factors at both the time of ICU admission and in the first 24 hours of ICU admission have been validated and shown to be capable of predicting delirium in critically ill adults. Positive delirium screening in critically ill adults is strongly associated with cognitive impairment at 3 and 12 months after ICU discharge and may be associated with a longer hospital stay. 3. Medical management General principles: 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 Show 2 more Management of sedation: 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 Management of sleep disturbance: consider using noise and light reduction strategies to improve sleep in critically ill adults. C Show 3 more 4. Specific circumstances Pediatric patients (management of delirium): use the preschool and pediatric Confusion Assessment Methods for the ICU or the Cornell Assessment for Pediatric Delirium as the most valid and reliable delirium monitoring tools in critically ill pediatric patients. A Show 8 more Pediatric patients (management of sedation): use the COMFORT-B scale or thr State Behavioral Scale to assess level of sedation in mechanically ventilated pediatric patients. B Show 11 more https://web.pathway.md/diseases/reccEXtBzUpU4rERP 2/3 6/24/23, 2:27 PM ICU delirium Pathway 5. Preventative measures Early mobilization: mobilize adult ICU patients as soon as safe and feasible, to reduce the incidence and duration of delirium. B Pharmacologic prophylaxis: consider avoiding the use of haloperidol, dexmedetomidine, statins, or ketamine to prevent delirium in critically ill adults. D Bright light therapy: consider avoiding the use of bright light therapy to reduce delirium in critically ill adults. D References 1. Barr J, Fraser GL, Puntillo K et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013 Jan;41 1 263 306. Open 2. Devlin JW, Skrobik Y, G linas C et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018 Sep;46 9):e825-e873. Open 3. Federico Coccolini, Francesco Corradi, Massimo Sartelli et al. Postoperative pain management in non- traumatic emergency general surgery: WSES GAIS SIAARTI AAST guidelines. World J Emerg Surg. 2022 Sep 21;17 1 50. Open 4. Heidi A B Smith, James B Besunder, Kristina A Betters et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med. 2022 Feb 1;23 2):e74-e110. Open 5. Suresh Arumugam, Ayman El-Menyar, Ammar Al-Hassani et al. Delirium in the Intensive Care Unit. J Emerg Trauma Shock. Jan-Mar 2017;10 1 37 46. Open 6. Rodrigo Cavallazzi, Mohamed Saad, Paul E Marik. Delirium in the ICU an overview. Ann Intensive Care. 2012 Dec 27;2 1 49. Open 7. Jason W W Thomason, Ayumi Shintani, Josh F Peterson et al. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care. 2005 Aug;9 4 R375 81. Open 8. Koen S Simons, Robert J F Laheij, Mark van den Boogaard et al. Dynamic light application therapy to reduce the incidence and duration of delirium in intensive-care patients: a randomised controlled trial. Lancet Respir Med. 2016 Mar;4 3 194 202. Open 9. Pratik P Pandharipande, Brenda T Pun, Daniel L Herr et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007 Dec 12;298 22 2644 53. Open 10. DAS Taskforce, Ralf Baron, Andreas Binder et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 DAS Guideline 2015 short version. Ger Med Sci. 2015 Nov 12;13 Doc19. 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