Delirium Management Guideline

Current Guideline Recommendations for Delirium Management

The American College of Critical Care Medicine recommends not routinely using haloperidol, atypical antipsychotics, or statins to treat delirium (conditional recommendation, low quality of evidence) 2
The American Society of Clinical Oncology suggests that olanzapine, quetiapine, and aripiprazole may offer some benefit in the symptomatic management of delirium [III-V, C] [1, 3]
Dexmedetomidine may be considered for delirium in mechanically ventilated adults where agitation is precluding weaning/extubation (conditional recommendation, low quality of evidence) 2
Benzodiazepines are effective at providing sedation and anxiolysis in the acute management of severe symptomatic distress associated with delirium [II, C] [1, 3]

Valproate requires careful liver function monitoring as it can cause hepatic impairment 4

Non-pharmacological interventions should be prioritized as the cornerstone of delirium management 1, 2
Identify and treat underlying causes of delirium (infections, metabolic disturbances, medication effects, etc.) 1, 3
In opioid-associated delirium, consider opioid rotation to fentanyl or methadone, or dose reduction [V, B] [1, 3]
Pharmacological interventions should be limited to patients with distressing delirium symptoms or safety concerns 3
For hyperactive delirium with severe distress or safety concerns, consider atypical antipsychotics like olanzapine, quetiapine, or aripiprazole at the lowest effective dose for the shortest time possible 1, 3
Reserve benzodiazepines for severe agitation or alcohol/benzodiazepine withdrawal 3
For hypoactive delirium without delusions or perceptual disturbances, methylphenidate may improve cognition [V, C] [1, 3]