key: cord-0754987-nvvzy2au
authors: Ista, Erwin; Nydahl, Peter
title: Delirium in adult and paediatric ICU patients: what is the way forward?
date: 2021-05-19
journal: Nurs Crit Care
DOI: 10.1111/nicc.12629
sha: 554ed121a5bd04151a435589c8d84fde0a574f38
doc_id: 754987
cord_uid: nvvzy2au

nan

dation of the delirium guideline. This is important because all healthcare professionals are busy, with many tasks and responsibilities, but if no one thinks about delirium, only the agitated patients will be noticed and, of note, only half of agitated patients actually have delirium. 6 We now know that there is a dose-response relationship in delirium: the longer delirium is present, the more serious consequences of delirium, such as prolonged mechanical ventilation, longer stay in the Intensive Care Unit (ICU) and hospital, impaired cognition and rehabilitation, and higher mortality. 2 Nevertheless, the implementation of delirium screening and prevention programs in adult and paediatric ICUs (PICU) is still challenging. This is especially so in critically ill children, in which regular monitoring of delirium with validated assessment tools was practiced in only 25% to 40% of PICUs. 7 In fact, the relationship seems to be U-shaped, with a high incidence in the early years, decreasing from 5 to 50 years, and then increasing again. These U-shaped relationships require advanced statistical procedures, and common linear regression analysis might be misleading. Some being delirious, and found days in coma and severity of illness as risk factors, both seen as non-modifiable. Whether days in coma is modifiable, is an interesting question. We would argue it might be, to some extent, e.g. by using frequent sedation assessment, targeted sedation, or bundles such as the ABCDEF (Assess, prevent, & manage pain; Both spontaneous awakening and spontaneous breathing trials;

Choice of analgesia and sedation; Delirium: assess, prevent, and manage; Early mobility and exercise; Family engagement and empowerment) bundle. 12 The authors used a tool for predicting the risk of delirium, the PRE-DELIRIC (PREdiction of DELIRium in ICu patients), developed by Boogaard et al. 13 This tool was evaluated by Liang et al in 375 mixed ICU patients with 44% being delirious. A higher PRE-DELIRIC score was associated with the development of delirium, age, length of stay in the ICU, and mortality. Such an instrument is not yet available for children. The authors conclude that a higher score might help us to identify patients at risk and to start early preventive interventions, especially in light of reduced nursing resources. This may be correct, but that does not mean it is easy.

There is no single intervention that targets delirium alone. Recommended delirium-preventing interventions such as early mobilization, family presence, and re-orientation are multifaceted and have more goals than delirium prevention alone. Mobilization supports physical rehabilitation, weaning, and the chance of an earlier

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