Current awareness of delirium in the ICU: a postal survey in The Netherlands
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KeywordsIntensive Care Unit Hospital Stay Emergency Medicine Haloperidol Pharmacological Treatment
Delirium in the ICU can compromise the recovery process, prolong the ICU and hospital stays and increase mortality. Therefore, recognition of delirium is of utmost importance.
To ascertain current attitude pertaining to delirium in critically ill patients, a simple questionnaire was sent to ICUs with ≥ 5 beds throughout The Netherlands.
From the number of units responding (n = 40, 53%), a delirium protocol was present in the majority of cases (n = 31, 78%), although implementation had occurred in only 16 ICUs (40%). Treatment of delirium was judged clinically important by 75% of the medical teams. The reported general incidence of delirium varied widely (<10% to 75%), but most participants thought it to occur in >25% of ventilated patients (n = 28, 70%) and in patients older than 50 years (n = 34, 85%). Most participating centers reported that they could certainly (n = 8, 20%) or most certainly (n = 21, 53%) identify delirium. A geriatrician or a psychiatrist predominantly diagnosed delirium (n = 27, 68%), while a screening instrument like the Dutch Confusion Assessment Method for the Intensive Care Unit was used in a minority of cases (n = 13, 33%). A geriatrician or a psychiatrist was consulted when patients were agitated (n = 32, 80%), or when routine pharmacological treatment had failed (n = 30, 75%). The frequency of checking for the presence of delirium varied from never (n = 12, 30%) to >3 times a day (n = 8, 20%). Delirium was predominantly treated with haloperidol (n = 30, 75%), while nonpharmacological measures were also taken frequently (n = 24, 60%).
In The Netherlands, delirium is considered an important problem in the ICU, although its incidence is thought to be low. Delirium is most frequently established by a geriatrician or psychiatrist after consultation. Efforts should be undertaken to implement delirium protocols and a routinely applied screening instrument in the ICU.
This article is published under license to BioMed Central Ltd.