Hypoactive delirium in the critical care setting

In hospitalized patients the rate of delirium can range from 19% to 82%, with the highest occurrence in the intensive care unit (ICU) population. In adult medical ICU patients, hypoactive delirium is substantially more common than hyperactive delirium (43.5% vs. 1.6%) and is frequently overlooked, leading to inadequate treatment and considerable risk for worse outcomes. National guidelines make no recommendation for the use of any specific pharmacologic agent for delirium prevention, therefore emphasis is placed on the choice of sedative and analysis of each sedative agent’s propensity to either cause or exacerbate delirium. Robust evidence for pharmacologic treatment of hypoactive delirium is currently lacking. Resolution of the underlying cause or causes of delirium remains at the forefront of treatment. Considering the clinical and financial consequences of delirium in the ICU, studies to further characterize and investigate the prevention and treatment of hypoactive delirium are needed to guide management. This chapter will focus largely on preventative strategies as well as some considerations for treatment of hypoactive delirium.