The Pharmacological Management of Delirium in Critical Illness

A growing body of evidence has shown that critical illness and associated treatments can lead to de novo neurological degradation manifesting as delirium or acute brain dysfunction. Many survivors further suffer from long-term cognitive impairment (LTCI), months to years after their critical illness, affecting their functional quality of life. Recent data have demonstrated that delirium is an independent risk factor for increased morbidity and mortality in the critically ill and may also predispose patients to long-term cognitive impairment. Delirium, therefore, may represent a critical point for intervention and treatment in critically ill patients. The pathogenesis of delirium is multifactorial and is considered to be related to several physiological and possibly iatrogenic processes. Due to its complexity, the optimum pharmacological treatment by which to manage delirium is not fully understood; however, recent investigations have proposed several plausible protocols. In this review, we examine evidence pertaining to the pharmacological treatment of delirium in the context of acute critical illness.