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Acute cognitive disorders: recognition and management of delirium in the cardiovascular intensive care unit 

Acute cognitive disorders: recognition and management of delirium in the cardiovascular intensive care unit
Chapter:
Acute cognitive disorders: recognition and management of delirium in the cardiovascular intensive care unit
Author(s):

John McPherson

, Jennifer Giuseffi

, Chad Wagner

, and E Wesley Ely

DOI:
10.1093/med/9780199687039.003.0074_update_001

February 22, 2018: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

The definition of delirium has been updated to reflect the DSM-5 definition

Recent prospective studies demonstrating the high-risk of long-term cognitive impairment in ICU survivors has been added

The Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in critically ill adults has been added as an important reference

Updated on 28 April 2016. The previous version of this content can be found here.
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date: 21 October 2019

Delirium is the most common acute cognitive disorder seen in critically ill patients in the cardiovascular intensive care unit. It is defined as a disturbance of consciousness and cognition that develops suddenly and fluctuates over time. Delirious patients can become hyperactive, hypoactive, or both. The occurrence of delirium during hospitalization is associated with increased in-hospital and long-term morbidity and mortality. The cause of delirium is multifactorial and may include imbalances in neurotransmitters, inflammatory mediators, metabolic disturbances, impaired sleep, and the use of sedatives and analgesics. Patients with advanced age, dementia, chronic illness, extensive vascular disease, and low cardiac output are at particular risk of developing delirium. Specialized bedside assessment tools are now available to rapidly diagnose delirium, even in mechanically ventilated patients. Increased awareness of delirium risk factors, in addition to non-pharmacological and pharmacological treatments for delirium, can be effective in reducing the incidence of delirium in cardiac patients and in minimizing adverse outcomes, once delirium occurs.

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