Initial Management of Delirium
Diagnosis and Assessment
- The American College of Physicians recommends using validated tools such as the Confusion Assessment Method (CAM) to objectively identify delirium 2
- Distinguish delirium from dementia by assessing onset, course, attention, and level of consciousness 1
- Evaluate for recent changes in cognitive function, behavior, or physical function, including impaired concentration, slow responses, withdrawal, sleep disturbances, hallucinations, confusion, agitation, or mood changes 1
Initial Workup
- Complete blood count, comprehensive metabolic panel, urinalysis, blood glucose measurement, and medication levels are recommended to assess for underlying causes of delirium 1, 2
- Electrocardiogram and chest radiography may be used to evaluate for myocardial ischemia, arrhythmias, pneumonia, or other pulmonary processes 2
Evaluation of Common Precipitating Factors
- Review all medications, especially vasodilators, diuretics, antipsychotics, sedative/hypnotics, and anticholinergics, which may contribute to delirium 1
- Consider opioid-induced neurotoxicity, especially in cancer patients, and opioid rotation with dose reduction may be beneficial 3, 4
Non-pharmacological Management
- Maintain normal sleep-wake cycles, provide appropriate sensory aids, and create a calm, well-lit environment to help manage delirium 1, 5
- Reorientation strategies and cognitive stimulation may be beneficial 5
Pharmacological Management
- Pharmacological interventions should be limited to patients with distressing symptoms or safety concerns, and medications should be used at the lowest effective dose and for the shortest time possible 1, 7
- Haloperidol, olanzapine, and quetiapine may be used as first-line options for moderate to severe symptomatic delirium 7, 8
Family Support and Education
- Provide families with information about delirium, and supplement written information with educational and psychological support 8