ICU Patient - Delirium Assessment
Screen all ICU patients routinely using validated tool
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ICU Delirium Prevention and Management
ICU Delirium Prevention and Management: ICU Patient - Delirium Assessment → Perform CAM-ICU or ICDSC → Delirium Present? → Continue Prevention Strategie...
Pathway Overview
14 steps
Algorithm Steps
14 total
01Start 02Action Perform CAM-ICU or ICDSC
Every shift (q8-12h) screening
- CAM-ICU: Acute onset + inattention + (disorganized thinking OR altered LOC)
- ICDSC: Score ≥4 = delirium
- Document screening results
- Cannot assess if RASS -4 or -5
03Decision Delirium Present?
CAM-ICU positive or ICDSC ≥4
04Action Continue Prevention Strategies
ABCDEF Bundle components
- A: Assess/manage pain
- B: Both SAT and SBT
- C: Choice of sedation (avoid benzos)
- D: Delirium monitoring
- E: Early mobility
- F: Family engagement
05Outcome Delirium Resolved
CAM-ICU negative, continue prevention
06Decision Delirium Subtype
Classify for targeted management
- Hyperactive: RASS +1 to +4, agitated
- Hypoactive: RASS -1 to -3, withdrawn
- Mixed: Fluctuates between both
07Action Address Underlying Causes (THINK)
Delirium is a symptom - find the cause
- T: Toxic (medications, substances)
- H: Hypoxia, Hypotension
- I: Infection, Inflammation
- N: Non-pharmacologic needs (sleep, glasses, hearing aids)
- K: K+ and electrolytes, Kidneys (uremia)
08Action Medication Review
Identify and eliminate delirium-causing drugs
- STOP: Benzodiazepines (if possible)
- STOP: Anticholinergics
- REVIEW: Opioids - minimize but treat pain
- AVOID: Steroids if not needed
- PREFER: Dexmedetomidine if sedation needed
09Action Non-Pharmacologic Interventions
First-line for ALL delirium
- Reorientation (clocks, windows, family)
- Sleep promotion (minimize nighttime interruptions)
- Early mobilization
- Sensory aids (glasses, hearing aids)
- Familiar objects, family presence
- Music therapy (PADIS: potential benefit)
10Action Consider Melatonin
PADIS 2025: Conditional for sleep/delirium
- Melatonin 3mg nightly
- Low risk intervention
- May improve sleep quality
- May reduce delirium incidence
11Action Daily Reassessment
Delirium duration correlates with outcomes
- Continue CAM-ICU q shift
- Track delirium-free days
- Escalate non-pharm interventions
- Taper/stop antipsychotics when improved
- Path rejoins step 05Shared downstream outcome
12Outcome Persistent Delirium
Continue management, reassess for underlying cause
13Decision Severe Agitation Threatening Safety?
Pharmacology for safety only - no mortality benefit
14Warning ⚠️ Antipsychotics (Limited Evidence)
PADIS 2025: No recommendation for or against
- Haloperidol 0.5-2mg IV q4-6h PRN
- Quetiapine 25-50mg PO BID
- ⚠️ QTc monitoring (hold if >500ms)
- ⚠️ No proven benefit on LOS or mortality
- Use lowest dose, shortest duration
- Path rejoins step 11Shared downstream outcome
- Path rejoins step 10Shared downstream outcome
Guideline Source
A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address alcohol withdrawal delirium (different treatment)
- Pharmacologic treatment has limited evidence for efficacy
- Requires trained staff for CAM-ICU assessment
- Does not cover pediatric delirium
- Hypoactive delirium often underdetected
Contraindicated Populations
pediatric
Applicable Regions
USEUGlobal
Global: PADIS guidelines widely recognized
Version 1Next review: 2028-01-01
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Frequently Asked Questions
What is the ICU Delirium Prevention and Management?
The ICU Delirium Prevention and Management is a management clinical algorithm for Critical Care. It provides a structured decision tree to guide clinical decision-making, based on A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.
What guideline is the ICU Delirium Prevention and Management based on?
This algorithm is based on A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (DOI: 10.1097/CCM.0000000000006574).
What are the limitations of the ICU Delirium Prevention and Management?
Known limitations include: Does not address alcohol withdrawal delirium (different treatment); Pharmacologic treatment has limited evidence for efficacy; Requires trained staff for CAM-ICU assessment; Does not cover pediatric delirium; Hypoactive delirium often underdetected. Individual patient factors may require deviation from these recommendations.
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