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Other signs and symptoms include:
■ Difficulty maintaining or shifting attention with low attention span.
■ Variation in levels of confusion; disorientation; fluctuations between lucidity
and confusion.
■ Illusions, paranoia, or hallucinations.
■ Fluctuating LOC with clouding of consciousness.
■ Dysphasia; dysarthria.
■ Tremor; motor abnormalities; asterixis if hepatic encephalopathy suspected.
■ Benzodiazepines such as lorazepam (Ativan) may cause or worsen delirium
and should be avoided. Opioid analgesics, metoclopramide, antidepres-
sants, H 2 antagonists and corticosteroids have also been identified as risk
factors for delirium development.
■ Newer neuroleptics preferred. Consider risperidone (Risperdal), olanzapine
(Zyprexa), and quetiapine (Seroquel).
■ Haloperidol (Haldol) previously was the drug of choice to treat delirium in
the ICU patient but has shown to have adverse neurological effects. If used,
monitor for QT prolongation.
Delirium Assessment Tools
The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score
is widely used to screen for delirium in the ICU population.
Confusion Assessment Method for the ICU (CAM-ICU) Flowsheet. Refer to:
http://www.mc.vanderbilt.edu/icudelirium/docs/CAM_ICU_flowsheet.pdf
Confusion Assessment Method for the ICU (CAM-ICU) Worksheet. Refer to:
http://www.mc.vanderbilt.edu/icudelirium/docs/CAM_ICU_worksheet.pdf
Assessment tools to predict delirium and severity of delirium in hospitalized
patients.
■ Mini-Cog
■ Intensive Care Delirium Severity Checklist (ICDSC)
■ Delirium Detection Scale (DDS)
Complications of Sedation, Agitation, and Delirium
Therapy
■ Hypotension
■ Patient unresponsiveness
■ Respiratory depression
■ Delayed weaning from mechanical ventilator
Complications associated with immobility: pressure ulcers, thromboem-
bolism, gastric ileus, hospital-acquired pneumonia

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