Delirium is an acute change in consciousness that is accompanied by inattention and either a change in cognition or perceptual disturbance. This form of acute brain dysfunction is associated with increased length of intensive care unit (ICU) and hospital stays, time receiving mechanical ventilation, mortality, and long-term cognitive impairment. Despite the high prevalence and the adverse outcomes, delirium in the ICU goes undetected and untreated in scores of patients.
Evaluate patients for potential risk factors for delirium. For pediatric patients, risk factors include presence of developmental delay, need for mechanical ventilation, and age 2–5 years. For adult patients, risk factors include older age, preexisting dementia, hypertension, pre-ICU emergency surgery or trauma, high severity of illness, mechanical ventilation, metabolic acidosis, coma, and multiple organ failure.
The following THINK mnemonic may be helpful in determining the cause when delirium is present: