Implementing the New PAD Guidelines

Delirium is an acute change in consciousness that is accompanied by inattention and a change in cognition or perceptual disturbance. A serious complication of ICU sedation, delirium affects up to 80% of ICU patients and is associated with increased length of stay, time on the ventilator, mortality, and long-term neuropsychological deficits. Yet, delirium goes undetected and untreated in more than 65% of cases. New SCCM guidelines for the management of pain, agitation, and delirium...
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Delirium is an acute change in consciousness that is accompanied by inattention and a change in cognition or perceptual disturbance. A serious complication of ICU sedation, delirium affects up to 80% of ICU patients and is associated with increased length of stay, time on the ventilator, mortality, and long-term neuropsychological deficits. Yet, delirium goes undetected and untreated in more than 65% of cases. New SCCM guidelines for the management of pain, agitation, and delirium (PAD) in adult ICU patients were published in January 2013. Capitalizing on recent advances in assessment-scale development, the PAD guidelines emphasize the use of valid, reliable tools for routine monitoring of ICU patients; these include the CAM-ICU and ICDSC to screen for delirium. This monograph focuses on the delirium component of the PAD guidelines. The author, Anne Pohlman, reviews the development of the guidelines and the importance of using validated assessment tools for detection and monitoring of delirium. She also presents the guidelines on delirium management, with strategies to improve ICU outcomes.