Delirium in the ICU & Critically Ill Patients

Unfortunately, delirium in ICU and critically ill patients is a quite common problem that we are having trouble making progress on controlling. It is quite frustrating when I am caring for a patient who has recovered from their main life-threatening insult to be left encephalopathic and the family constantly asking “what’s wrong”. The most common response I provide that family member is “they need some time”. Definitely not the answer they want to hear from me, nor is it the answer I want to provide to them, but it is what it is. In this post, I will try my best to review and provide as many citations as possible regarding ICU delirium and delirium in the critically ill. It will be a work in progress and will likely never be complete as this will be a constantly updated page. First created on 11/04/21. Last update 02/26/23. CLICK HERE for the latest trial on Haldol.

Phenotypes and sub-phenotypes
Therapies
- Melatonin
- Thiamine
- Natural Light (not the beer)
- Earplugs
- Physical Activity

Phenotypes and Subphenotypes of Delirium

This article was shared on my social media platforms on 11/4/21. If you are here just to download the paper (and not trust me)… the citation is right below.

Bowman EML, Cunningham EL, Page VJ, McAuley DF. Phenotypes and subphenotypes of delirium: a review of current categorisations and suggestions for progression. Crit Care. 2021 Sep 15;25(1):334. doi: 10.1186/s13054-021-03752-w. PMID: 34526093; PMCID: PMC8441952.
Link to Article
Link to FULL FREE PDF

Sepsis-Associated Delirium

Tokuda R, Nakamura K, Takatani Y, Tanaka C, Kondo Y, Ohbe H, Kamijo H, Otake K, Nakamura A, Ishikura H, Kawazoe Y, J-STAD (Japan Sepsis Treatment and Diagnosis) Study Group. Sepsis-Associated Delirium: A Narrative Review. Journal of Clinical Medicine. 2023; 12(4):1273. https://doi.org/10.3390/jcm12041273
Link to Article
Link to FULL FREE PDF

Therapies for ICU Delirium: Natural Light

I covered this in the past in THIS POST.

Therapies for Delirium: Melatonin

I covered this in the past in THIS POST.

Should we be using earplugs in our ICU patients to avoid delirium

Litton E, Elliott R, Ferrier J, Webb SAR. Quality sleep using earplugs in the intensive care unit: the QUIET pilot randomised controlled trial. Crit Care Resusc. 2017 Jun;19(2):128-133. PMID: 28651508.
Link to Article (NOT FREE)

Physical Activity/Therapy for ICU Delirium

Jarman A, Chapman K, Vollam S, Stiger R, Williams M, Gustafson O. Investigating the impact of physical activity interventions on delirium outcomes in intensive care unit patients: A systematic review and meta-analysis. Journal of the Intensive Care Society. 2023;24(1):85-95. doi:10.1177/17511437221103689
Link to Article
Link to FULL FREE PDF

Citations for ICU Delirium

Smonig R, Magalhaes E, Bouadma L, Andremont O, de Montmollin E, Essardy F, Mourvillier B, Lebut J, Dupuis C, Neuville M, Lermuzeaux M, Timsit JF, Sonneville R. Impact of natural light exposure on delirium burden in adult patients receiving invasive mechanical ventilation in the ICU: a prospective study. Ann Intensive Care. 2019 Oct 17;9(1):120. doi: 10.1186/s13613-019-0592-x. PMID: 31624936; PMCID: PMC6797676.
Link to Article
Link to FULL FREE PDF

Ng KT, Teoh WY, Khor AJ. The effect of melatonin on delirium in hospitalised patients: A systematic review and meta-analyses with trial sequential analysis. J Clin Anesth. 2020 Feb;59:74-81. doi: 10.1016/j.jclinane.2019.06.027. Epub 2019 Jul 3. PMID: 31279283.
Link to Article

Bowman EML, Cunningham EL, Page VJ, McAuley DF. Phenotypes and subphenotypes of delirium: a review of current categorisations and suggestions for progression. Crit Care. 2021 Sep 15;25(1):334. doi: 10.1186/s13054-021-03752-w. PMID: 34526093; PMCID: PMC8441952.
Link to Article
Link to FULL FREE PDF

Litton E, Elliott R, Ferrier J, Webb SAR. Quality sleep using earplugs in the intensive care unit: the QUIET pilot randomised controlled trial. Crit Care Resusc. 2017 Jun;19(2):128-133. PMID: 28651508.
Link to Article (NOT FREE)

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