Delirium primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishal Khurana, M.B.B.S., M.D. [2]

Overview

Primary Prevention

Delirium is more likely to be missed in the ICU. Physician detection rate is poor, reported sensitivity is 29%.

Society of Critical Care Medicine (SCCM) and the American Psychiatric Association (APA) recommends daily monitoring of delirium in ICU patients to improve early diagnosis and treatment.

the Confusion Assessment Method for the ICU (CAM-ICU) showed highest sensitivity in a research setting, ranging from 64% to 97%. 9,12 However, in routine, daily practice the sensitivity of the CAM-ICU appeared to be much lower (47%).

CAM-ICU are that it cannot quantify delirium severity and that it assesses delirium at a certain moment in time, 12 whereas delirium may fluctuate considerably over the day. 1 These factors impede recognition and thereby delay treatment. Delayed treatment of delirium was found to be related to mortality. 14 Therefore, an objective detection tool for continuous monitoring of delirium is needed

that the most successful approach to delirium prevention is to attenuate modifiable risk factors in individual patients. This requires a complex intervention, and studies investigating such interventions in medical patients and those who have had hip fracture have reported significant reductions (of about a third) in incidence of delirium and/or reduced severity and duration of delirium.