The treatment of delirium is multifactorial, including environmental stimulation, ongoing mobilization and family presence. Guidelines recommend against using benzodiazepines for sedation, unless otherwise indicated (e.g., withdrawal related to alcohol or benzodiazepine use). The inappropriate administration of benzodiazepines may harm a critically ill patient by inadvertently increasing the incidence of delirium or the length of stay in an ICU. Nonpharmacologic strategies should be used, along with monitoring, assessing and treating pain. Preliminary research has shown that implementing nurse-driven daily awakening protocols and best practice bundles such as ABCDE may improve outcomes, including decreases in length of overall hospital stay, ventilator days and risk of ICU-acquired delirium. For more information:
American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. American Geriatrics Society Abstracted Clinical Practice Guideline for Postoperative Delirium in Older Adults. J Am Geriatr Soc; 2015 Jan;63(1):142-50. PMID: 25495432.
American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc.; 2015 Nov;63(11):2227-46. PMID: 26446832.
Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013 Jan;41(1):263-306. PMID: 23269131.
Campbell N, Boustani MA, Ayub A, Fox GC, Munger SL, Ott C, Guzman O, Farber M, Ademuyiwa A, Singh R. Pharmacological management of delirium in hospitalized adults—a systematic evidence review. J Gen Intern Med; 2009 Jul;24(7):848-53. PMID: 19424763.
The American Geriatrics Society 2019 Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society; 2019;67(4):674-94. PMID: 30693946.