From the Guidelines
The best way to treat ICU delirium is by implementing a multicomponent, nonpharmacologic intervention, as recommended by the most recent and highest quality study 1, which suggests using a multimodal approach that includes multimodal sensory, cognitive, and emotional stimulation, such as mobilization, purposeful stimulation and engagement, aids for orientation, and contact with family members. This approach has been shown to reduce delirium incidence, duration, and severity, as well as improve patient outcomes, including reduced mortality and ICU length of stay. Key components of this approach include:
- Implementing the ABCDEF bundle: Assess and manage pain, Both spontaneous awakening and breathing trials, Choice of sedation minimized, Delirium monitoring and management, Early mobility, and Family engagement
- Environmental modifications, such as maintaining day-night cycles, reducing unnecessary noise, and promoting normal sleep patterns
- Minimizing use of physical restraints and removing unnecessary medical devices
- Addressing underlying causes, such as treating infections, correcting metabolic abnormalities, managing pain, and reviewing medications that may contribute to delirium
- Early mobilization and physical therapy to reduce delirium duration and severity Pharmacological management, such as using low-dose antipsychotics or dexmedetomidine, may be considered for severe agitation or psychotic symptoms, but should not be used as a first-line treatment, as they do not reduce delirium duration, as noted in studies 1. Overall, a comprehensive and multimodal approach to treating ICU delirium is essential to improve patient outcomes and reduce morbidity and mortality.
From the Research
Non-Pharmacologic Interventions
- Non-pharmacologic interventions such as early mobilization, earplugs and blinds at night, music and natural sunlight during the day, continuous reorientation, and increased visitation and family participation are essential to integrate into the treatment plan for the management of delirium in the ICU 2
- Multicomponent non-pharmacologic interventions have been shown to be efficacious in reducing the incidence and duration of delirium in ICU patients 3, 4
- Light therapy can improve the patient's circadian rhythm and thus contribute to reducing the incidence of delirium 3
Pharmacologic Interventions
- Antipsychotics have been shown to be ineffective in preventing or shortening the duration of delirium in ICU patients 4
- Quetiapine has been shown to be effective in preventing delirium in high-risk, surgical trauma ICU patients 5
- Quetiapine has also been used in the management of refractory hyperactive and mixed ICU delirium, with a reduction in the need for other medications and resolution of delirium within a median of four days 6
Multicomponent Interventions
- The ABCDEF bundle, a multicomponent strategy, has been adopted in the ICU with several studies showing a potential benefit in delirium outcomes 4
- Multicomponent interventions are the most promising methods in the fight against delirium, and the patient's family is an important part of the process and should be included in the delirium prevention scheme 3