Delirium prevention and management—less sedation and keep moving!
Delirium is a highly prevalent syndrome in critical care patients, and its impact on patients’ outcome is becoming increasingly recognized. Delirium is defined by the DSM-5 as an acute disorder of attention and consciousness, occurring in up to 80% of hospitalized patients in intensive care and is a predictor of several adverse events. There are many pathophysiological mechanisms implicated in the development of delirium ranging from alterations in neurotransmitter balance to brain inflammation. Delirium is a direct consequence of a medical condition, and may be induced by acute organ dysfunction or disease, so prompt treatment of the underlying condition is needed to reduce the incidence, severity, and duration of delirium. Though with a low level of evidence, administration of antipsychotic medications is recommended by various international guidelines and is the most used drug class to treat delirium. Prevention, with great emphasis on non-pharmacological measures, and recognition strategies are of utmost importance to deliver proper treatment and avoid worse outcomes in this group.