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(BQ) Part 2 book "Principles of critical care" presents the following contents: Neurologic disorders, hematologic and oncologic disorders, renal and metabolic disorders, gastrointestinal disorders, the surgical patient, special problems in critical care. | PART 6 Neurologic Disorders 756 PART 6 Neurologic Disorders CHAPTER 82 Delirium in the Intensive Care Unit Nathan E. Brummel Timothy D. Girard INTRODUCTION Patients in the intensive care unit ICU who experience delirium are exhibiting an under-recognized form of organ dysfunction. Delirium is extremely common in ICU patients as factors such as comorbidity the acute critical illness itself and iatrogenesis intersect to create a high-risk setting for delirium. This neurologic complication is often hazardous being associated with death prolonged hospital stays and long-term cognitive impairment and institutionalization. Neurologic dysfunction compromises patients ability to be removed from mechanical ventilation or to fully recover and regain independence. Unfortunately health care providers in the ICU are unaware of delirium in many circumstances especially those in which the patient s delirium is manifesting predominantly as the hypoactive quiet subtype rather than the hyperactive agitated subtype. Despite being often overlooked clinically ICU delirium has increasingly been the subject of research during the past decade which has brought to light the scope of the problem in critically ill patients and provided clinicians with tools for routinely monitoring delirium at the bedside. This chapter reviews the definition and salient features of delirium its primary risk factors including drugs associated with the development of delirium proposed pathophysiologic mechanisms validated methods for bedside delirium assessment and nonphar-macologic and pharmacologic strategies for delirium management. DEFINITION AND TERMINOLOGY The American Psychological Associations APA Diagnostic and Statistical Manual of Mental Disorders DSM -IV describes delirium as a disturbance in consciousness and cognition that develops over a short period of time eg hours to days and tends to fluctuate during the course of the day. 1 2 3 Specifically there are four criteria required to diagnose .
