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Arch Hellen Med, 32(3), May-June 2015, 263-269


Delirium in the intensive care unit patient:
A review of the current approaches to diagnosis and treatment

G. Giavasi, L. Samartzis, S. Nanas
First University Department of Intensive Care, National and Kapodistrian University of Athens, "Evangelismos" General Hospital, Athens, Greece

Delirium is an organic psychosyndrome which commonly develops in patients in the intensive care unit (ICU). Older patients suffer more often from the syndrome. It is recognized that delirium has a great impact on the disease course of patients, leading to an increase in mortality and healthcare costs. It prolongs hospital stay and extends the use of mechanical ventilation, and it is associated with increased risk of long-term cognitive dysfunction. Preventive measures for the syndrome focus firstly on identifying the patients who are at risk of developing delirium. Prevention of delirium also includes multicomponent interventions that eliminate the risk factors for the syndrome, and the nursing staff plays a primary role in their implementation. The preventive measures, the effectiveness of which has been verified in numerous studies include treatment of the underlying disease, early mobilization, intervention to orient the patient, use of restorative measures in the case of sensory or physical deficit, and effective pain management. The non-pharmacological interventions are similar to the preventive measures. The administration of antipsychotics and the restrained use of anticholinergic medications are recommended as pharmacological treatment for delirium. Haloperidol plays a major role among pharmacological measures, although its use is not accompanied by a reduction of the duration of syndrome. Atypical antipsychotics are equally effective; they reduce the duration of the syndrome and have fewer side effects than classic neuroleptics. Current guidelines recommend the use of benzodiazepines in the treatment of delirium associated with withdrawal from alcohol. In order to achieve better results in the management of delirium, pain and aggression, guidelines recommend a low level of sedation or daily interruption of sedation for a determined time for mechanically ventilated patients in the ICU. The identification of areas that have been less well studied is of importance, so that they can constitute the focal point of future research.

Key words: Haloperidol, Delirium, ICU, Sedation.

© Archives of Hellenic Medicine