Definition = impaired lucidity (disturbed perception, thinking, memory, action).

The most important for ICU is delirium. 

ICU delirium 

Delirium = acute organic cerebral syndrome within the ICU setting, which is not explainable by previous neurological disorders. 

Types: 

• Hypoactive.
• Hyperactive - very tricky to diagnose but also very frequent.
• Mixed.

Symptoms: attention difficulties, short-term memory deterioration, disorientation, alexia, apraxia, night terrors, behavior disorders, emotion disturbance, aggressivity...

Etiology: 

• Risk factors - age, frailty, dementia, alcohol abuse, benzodiazepine abuse.
• Causes - sepsis, hypotension, hypertension, pain, surgery, withdrawal syndrome...
• Risk medication - benzodiazepines, opioids, anticholinergic drugs...

Diagnostics: 

• 1. Regular screening for signs of delirium. 
• 2. Excluding other causes of consciousness disturbance.

Therapy and prevention: 

• 1. Non-pharmacologic approach
  • Remind the patient of his location, time, and date, give them their glasses or hearing devices, and place the clocks in every room...
  • Early mobilisation.
  • Maintain sleep-wake cycle - the ICU should be as quiet and dark as possible at night.
• 2. Pharmacologic approach - haloperidol, atypical antipsychotic (e.g. quetiapine), dexmedetomidine (Only to relieve or eliminate psychomotor agitation, reducing the risk of self-harm, not administered preventive),  benzodiazepines only in case of withdrawal syndrome.