Delirium in the ICU

Patients in the intensive care unit (ICU) can experience a condition called delirium. Delirium occurs over a short period of time (hours to days) and involves inattention and severe confusion. It can impair a person’s ability to receive, process, store, and recall information.

A patient may experience delirium in the ICU due to:

  • Sedation medications
  • Poor sleep
  • Unfamiliar environment and sounds
  • Stress, pain
  • Frequent monitoring and assessments
  • Underlying illness

How to Help Prevent Delirium 

If you have a friend or family member who is at risk for delirium, you can do things to help. There's no guarantee that these measures will prevent delirium. Delirium isn't always preventable. That’s because sometimes delirium results from infections, medicines, or other causes that a healthcare provider must address. But they may reduce risk.

5 steps for prevention

It may take days, weeks, or even months for delirium to go away. So prevention is important. In some cases, a person may not fully recover. Here are some steps you can take:

Step 1. Help the person stay focused and present

  • Announce visitors when they enter the room.

  • Make sure the person has access to eyeglasses, if needed.

  • Make sure the person has a working hearing aid, if needed.

  • Keep a regular routine for the person during the day.

  • Put a clock and calendar in the room. Mention the day, date, and time throughout the day. Keep the person oriented to place and date.

  • Tell the person when it’s time for something, such as a meal, physical activity, or bedtime.

  • Put a few familiar objects around the room.

  • Make sure the person has a window and can see the outdoors and sunlight.

  • Make sure the room has good lighting during the day even if it’s dark outside.

  • Put a TV or radio in the room so the person can keep in touch with the outside world.

  • Encourage the person to be active during the day, and keep a normal sleep schedule at night.

Step 2. Keep a calm environment

  • Limit the number of people allowed in the person’s room.

  • Talk with the person calmly.

  • Don’t argue with the person.

  • Keep noise levels low.

  • Don’t play loud music or have the TV volume too loud.

  • If at home, keep noisy children at a distance when possible.

  • Take unneeded objects away and don’t let the room get cluttered. But some familiar objects may be helpful to keep the person oriented.

  • Make sure the room is a comfortable temperature.

Step 3. Help the person get good sleep

  • Make sure the person keeps to regular sleep and wake times.

  • Dim the lights in the evening. Turn off room and hallways lights after bedtime. Turn off the TV at night.

  • Reduce lights and sounds from medical machines at night.

  • Keep the room quiet at night.

  • Keep the room bright with lights and open curtains during the day.

  • Make sure the person doesn't have caffeine after noon.

  • Ask hospital staff and others to limit unneeded nighttime visits.

  • Give the person sleep aids, such as an eye mask or ear plugs. Don't give the person sleeping pills.

  • Ask the person if they're sleeping through the night. (Note: A delirious person may not be able to give an accurate history.)

Step 4. Help the person stay healthy

  • Make sure the person eats a healthy diet on a regular meal schedule.

  • Make sure the person drinks enough fluids, especially if they have diarrhea, fever, or other symptoms that can cause dehydration.

  • Make sure the person has regular bowel and bladder habits.

  • Make sure they take all medicine, as needed, on schedule.

  • Help the person get regular physical activity, if possible.

  • Tell the person’s healthcare provider right away if you see signs of a health concern, such as fever, pain, or any change in condition.

Step 5. Keep in contact with healthcare providers

  • Ask the person’s healthcare provider about their medicines. Some medicines can cause delirium.

  • Get help if the person needs to stop taking alcohol or psychoactive medicines.

When you need support

Talk with your healthcare provider about your role as a caregiver. Your provider may have information for you about support groups and other resources.