In the last decade, research has led to an increased aware­ness that the med­ica­tion and non­med­ica­tion strate­gies used in a hospital’s intensive-​​care unit to treat pain, agi­ta­tion and delirium may have impor­tant effects on post-​​ICU out­comes, according to John Devlin, asso­ciate pro­fessor of phar­macy prac­tice in Northeastern’s Bouvé Col­lege of Health Sci­ences.

Last month, Devlin was the first critical-​​care phar­ma­cist to be invited to present at the Inter­na­tional Sym­po­sium on Inten­sive Care and Emer­gency Med­i­cine in Brus­sels, Bel­gium, where he spoke about delirium pre­ven­tion and man­age­ment and his National Insti­tutes of Aging-​​funded research in this area.

Eighty per­cent of ICU patients expe­ri­ence delirium, a con­di­tion char­ac­ter­ized by sudden con­fu­sion and a rapid change in brain func­tion. It is asso­ci­ated with increased mor­tality, pro­longed hos­pital length of stay and long-​​term cog­ni­tive and func­tional decline, Devlin said.

We’ve real­ized over the last decade that patients who develop delirium while in the ICU are put on a dif­ferent post-​​ICU tra­jec­tory that can alter their dis­po­si­tion and quality of life,” he said, noting this is par­tic­u­larly true among the elderly.

Later this year, the Society of Crit­ical Care Med­i­cine will pub­lish new con­sensus guide­lines defining best prac­tices for the pre­ven­tion and treat­ment of pain, agi­ta­tion and delirium. Devlin and 15 other leaders in the field, including phar­ma­cists, nurses, inten­sivists and psy­chi­a­trists, devel­oped these evidence-​​based guide­lines as a road map for ICU clin­i­cians at the bed­side and to iden­tify the most pressing research ques­tions in this area.

There are never enough resources in any hos­pital to have a psy­chi­a­trist or neu­rol­o­gist eval­uate all ICU patients with sus­pected delirium on a 24–7 basis.  So bed­side clin­i­cians, par­tic­u­larly nurses, must reg­u­larly eval­uate patients for signs of delirium.” These assess­ments allow an ICU team to eval­uate delirium risk fac­tors and con­sider treat­ment strategies.

Addi­tion­ally, ICU clin­i­cians can do a variety of things to pre­vent delirium, Devlin said. The guide­lines rec­om­mend that patients be taken off seda­tion for short periods every day until they wake up and that they be mobi­lized, with the help of phys­io­ther­a­pists, early in their ICU stay. The guide­lines also rec­om­mend that med­ica­tions shown to reduce delirium be used over those that have not.

Inter­ven­tions shown to pre­vent delirium in the ICU have been found to have a much greater impact on patient out­come than the drug and non­drug ther­a­pies that may be imple­mented after delirium develops,” Devlin said.

Devlin and his col­leagues hope that the new guide­lines will serve as a valu­able tool for ini­ti­ating con­ver­sa­tions between the inter­dis­ci­pli­nary ICU teams as they make deci­sions about how best to main­tain their patients’ com­fort but also pro­vide the care that will boost post-​​ICU func­tion­ality and psy­cho­log­ical health.