How to monitor delirium in the ICU and why it is important

Abstract

Delirium is a severe organic dysfunction of the brain with a decline in attention and cognition. It is characterized by an acute onset with a tendency to fluctuate and impaired consciousness with reduced clarity of awareness. Furthermore it is designated by a reduced ability to focus, sustain, or shift attention and a change in cognition or a perceptual disturbance with hallucinations.

Up to 20% of hospitalized patients older than 65 years are affected, in an intensive care setting reports go up to 80%. Once delirium developed, it is associated with poor cognitive outcome, dementia and increased costs. Delirium is an independent predictor of mortality and prolonged stay in the intensive care unit (ICU) and hospital.

For early diagnosis of delirium, monitoring is required in daily routine. Symptoms of and reasons for delirium are very variable. The application of special scales to assess delirium should be performed. The “Delirium Detection Scale” (DDS) and the “Confusion Assessment Method” (CAM-ICU) are both validated and reliable measurements for delirium in ICU patients. Any possible general medical condition must be excluded.

This overview article is to demonstrate the importance of a tight monitoring to enable optimal treatment and to save patients from associated complications like prolonged stay in ICU and hospital, increased mortality, poor cognitive outcome and increased costs.