LAUSR

Delirium is a severe and frequent condition that occurs in 20–40% of patients admitted to the intensive care unit (ICU), with higher rates of 60–80% described in mechanically ventilated patients. The accumulated evidence in the past decades demonstrates that delirium is clearly associated with hospital mortality, lengths of stay, duration of mechanical ventilation and costs [1, 2]. Moreover, the presence of delirium and its duration and severity are risk factors for long-term cognitive impairment in patients surviving critical illness [1]. Although agitated (hyperactive) delirium attracts the intensivist’s attention and frequently requires interventions to prevent self-harm and control the symptoms, the hypoactive and mixed forms are extremely common and frequently associated with poor outcomes. However, to correctly diagnose patients with delirium regardless of its presentation form, it is mandatory to use valid and reproducible screening tools such as the Confusion Assessment Method for the ICU (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC). Despite the increasing knowledge on epidemiology, risk factors and potential preventive and therapeutic interventions [3], the rates of delirium and its associated mortality remain elevated. In a recent worldwide survey, we found that knowledge translation in terms of the application of the best current available evidence to prevent delirium is largely incomplete [4]. Recent quality improvement studies also showed that adherence to current recommendations on delirium and sedation management is low [5, 6]. In this scenario, a daily challenge for clinicians caring for the critically ill ensues when, after screening patients for delirium and making the diagnostic, they are faced with the question: “What should I do now? Does this patient with delirium require drug treatment?” Let us state that implementation of non-pharmacologic strategies to prevent and treat ICU delirium are of paramount importance (Fig. 1) and should be targeted as main goals of ICU quality improvement projects. We are far from achieving this goal; we only have to consider that the majority of ICUs worldwide still have restrictive ICU visitation policies for family members despite knowledge that an extended visitation policy is associated with reductions in the occurrence of delirium [7].