Delirium in the ICU

[AngelaHarvey]

I am finishing my BSN and have elected to do my capstone on delirium in the ICU, how it is detected, and medication used to help with it. Please give me feed back on your hospital protocols!

[MunoRN, RN]

Vanderbilt has a good research center on ICU delirium: ICU Delirium and Cognitive Impairment Study Group

It goes into prevention, diagnosis, assessment tools, treatments, etc. Maybe look at that first and then see what questions you have.

[Vikingnurse]

In my unit we focus a lot on delirium. Primarily because we have a no sedation protocol for our ventilated patients. That protocol in itself is step to minimizing or prevent delirium. Sedation on top of severe sepsis and mechanical ventilation and the patient will for sure develop delirium.

Our protocol focus on non pharmacological interventions such as mobilization, reorientation and of course the most important thing - treating the underlying causes.

Pharmacologic treatment is olanzapin 5-10 mg in the evening, for more severe agitation we tend to start with 1-2 mg of midazolam. Our expirence is that those small doses are often enough. If the patient seems delucional and agitated with a RASS > +2 we can use haloperidol. Starting with 1 or 2 mg and double it with 20-30 min. intervals. 1-2-4-8 mg. If we don't have effect of 8 mg we use larger doses of midazolam or sedate the patient.

[calivianya, BSN, RN]

Staying away from benzos is a good start. We almost never use Versed/Ativan/etc. for anything. Instead, we have a pain/analgesia/delirium protocol that we use for sedation that requires us to start with Fentanyl pushes. We can give 25, 50, or 100mcgs every 15 minutes until pain is controlled. If the patient requires more than 3 PRN doses in two hours, we can start a Fentanyl drip. If we get to 200mcgs on the Fentanyl drip and the patient is still crazy, that's when we call the physician for something else. Most people are pretty chilled out well before 200mcgs of Fentanyl, and it is not mind altering the way benzos are. For those patients that are still nuts on 200mcgs of Fentanyl, we usually start propofol on the vented patients and precedex on the non-vented patients, or we raise the limit on the Fentanyl.