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Encephalopathy and Delirium 

Encephalopathy and Delirium
Chapter:
Encephalopathy and Delirium
Author(s):

Joshua Keegan

, and Colleen Moran

DOI:
10.1093/med/9780199375349.003.0002
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date: 31 March 2020

Delirium has high prevalence in the intensive care unit (ICU) and carries high morbidity. Delirium is often underrecognized, and implementation of validated screening strategies increases detection rates. Strategies to minimize delirium include limitation or avoidance of certain medications (especially benzodiazepines), frequent reorientation, maintenance of normal sleep/wake cycles, and provision of hearing and vision aids. Optimal treatment of delirium once it occurs is unclear, but antipsychotics may have beneficial effects. Sedative medications to manage pain and agitation are often necessary in the ICU; however, they may contribute to delirium. The agent used should be targeted to the patient’s specific situation. Daily sedation interruptions and targeting light rather than deep sedation help to minimize the doses used. In a subset of patients specific to the neurologic ICU, deeper sedation may be required to avoid intracranial pressure crises.

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