Delirium Management in the Critic Geriatric Patient: An Updated Approach

Abstract

Delirium or acute confusional syndrome is a common problem in geriatric patients, although its diagnosis is often overlooked, especially in its hypoactive form. Risk factors for delirium are previous cognitive alterations and certain comorbidities, different environmental factors and acute organic alterations typical of critically ill patients. Delirium is associated with increased short- and long-term mortality, to the prolongation of mechanical ventilation, to prolonged stays in the Intensive Care Unit (ICU) and in the hospital and to cognitive deterioration after hospital discharge. In recent years, specific tools have been developed for the detection of delirium in ICU.

The implementation of specific interventions on certain risk factors can reduce the incidence of delirium in hospitalized patients. The treatment of delirium it is based on identifying and correcting the underlying causes, establishing support measures and, sometimes, pharmacological treatment to control symptoms. Haloperidol is the first-line drug for the control of delirium, since experience with atypical neuroleptics, such as olanzapine and risperidone, as well as with other drugs, it is insufficient to be able to make recommendations on their use. Neuroleptics can have serious side effects that must be taken into account. In cases with agitation, the simultaneous use of benzodiazepines or propofol may be necessary and, sometimes, in a temporary and protocolized manner, the use of physical restraints.