Issue: 2009 > July-August > special report

Current awareness of delirium in the intensive care unit: a postal survey in the Netherlands

F.L. Cadogan, B. Riekerk, R. Vreeswijk, J.H. Rommes, A.C. Toornvliet, M.L.H. Honing, P.E. Spronk


Background: Delirium in the ICU can compromise the
recovery process, prolong ICU and hospital stay and
increase mortality. Therefore, recognition of delirium is of utmost importance. Methods: To ascertain current attitude pertaining to delirium in critically ill patients a simple questionnaire was sent to all intensive care units (ICUs) throughout the Netherlands. Results: Seventy-five questionnaires were sent and 44 returned. A delirium protocol was present in the majority of cases (n=35, 80%), although implementation had occurred in only 22 ICUs (50%). The reported general incidence of delirium varied widely (<10-75%), but most participants thought it to occur in >25% of ventilated patients (n=33, 75%) and in patients older than 70 (n=38, 86%). Most participating centres reported that they could certainly (n=9, 20%) or most certainly (n=22, 50%) identify delirium. A geriatrician or a psychiatrist predominantly diagnosed delirium (n=30, 68%), while a diagnostic instrument such as the CAM -ICU was used in a minority of cases (n=11, 25%). A geriatrician or a psychiatrist was consulted when patients were agitated (n=40, 90%), or when routine pharmacological treatment
had failed (n=40, 91%). Conclusion: In the Netherlands, delirium is considered an important problem in the ICU, although its incidence is estimated to be low by the ICU team. The diagnosis of delirium is most frequently established by a geriatrician or psychiatrist after consultation, while diagnostic instruments are
infrequently used. Efforts should be undertaken to
implement delirium protocols and a routinely applied
diagnostic instrument in the ICU.