Delirium is defined as “a syndrome characterized by the acute onset of cerebral dysfunction with a change or fluctuation in baseline mental status, inattention, and either disorganized thinking or an altered level of consciousness.”1(p282) Delirium has been associated with increased mortality, prolonged hospital and intensive care unit (ICU) stays, and the development of post-ICU cognitive impairment.1  Bedside clinicians must be able to identify both hyperactive and hypoactive delirium, between which patients may fluctuate (ie, have mixed delirium). Hyperactive delirium typically involves agitation, hallucinations, and delusions, whereas patients with hypoactive delirium may be calm or lethargic while experiencing confusion and sedation.

In 2018 the Society of Critical Care Medicine published updated Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS guidelines).2  Important updates from prior guidelines were a new focus on delirium prevention...

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