Tag Archives: delirium


ABCDE of ICU cognitive outcomes

Applying best evidence using simple easily remembered tools appeals to my small and busy brain. A system of minimising the impact of intensive care on long term brain function is proposed using an ABCDE mnemonic: awakening, spontaneous breathing trials, coordinating these two with target-based sedation, delirium monitoring and scoring, and early mobility therapy / exercise.

A screening, prevention, and restoration model for saving the injured brain in intensive care unit survivors
Critical Care Medicine Oct 2010;38(10):S683-S691

Delirium guidelines

The UK’s National Institute for Health and Clinical Excellence (NICE) has produced guidelines on delirium.

Delirium (sometimes called ‘acute confusional state’) is a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course.

Some snippets from the guideline include:

  • If indicators of delirium are identified, carry out a clinical assessment based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria or short Confusion Assessment Method (short CAM) to confirm the diagnosis.
  • In critical care or in the recovery room after surgery, CAM-ICU should be used. A healthcare professional who is trained and competent in the diagnosis of delirium should carry out the assessment.
  • If there is difficulty distinguishing between the diagnoses of delirium, dementia or delirium superimposed on dementia, treat for delirium first.
  • If a person with delirium is distressed or considered a risk to themselves or others and verbal and non-verbal de-escalation techniques are ineffective or inappropriate, consider giving short- term (usually for 1 week or less) haloperidol or olanzapine.

The CAM-ICU assessment tool is demonstrated in the video below, which is found along with other helpful delirium resources at http://www.icudelirium.co.uk

NICE Guidance: Delirium: diagnosis, prevention and management