Diagnosis of delirium in patients admitted to an Intensive Care Unit: an integrative review





Delirium; ICU; Mechanical ventilation; Diagnosis.


Delirium in adults admitted to an intensive care unit may be related to mechanical ventilation, the use of sedatives and prolonged ICU stay, being associated with worse clinical conditions and hospital outcomes. Objectives: to investigate the diagnosis of delirium in ICU patients and how it influences the admission of these patients. Methodology: an integrative and exploratory review study. A search for studies was performed in the MEDLINE, PubMed and LILACS databases, with the following descriptors: delirium and ICU and mechanical ventilation and diagnosis. Results: 14 studies were included, being: 5 carried out in Europe, 4 in Asia, 2 in North America and 1 in South America, in addition to two bicentric studies. The severity of the dysfunction is related to older patients, with longer mechanical ventilation, longer sedation and days of hospitalization. Among the diagnostic assessment instruments, the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) obtained a satisfactory response among the analyzed studies. Conclusion: the most effective strategy to reduce delirium is primary prevention, such as investment in human resources, use of non-pharmacological measures and changes in the management of the dysfunction. The correct and early diagnosis of delirium can have a positive impact on the prognosis of patients in the ICU, reducing the organic repercussions and morbidity and mortality of these patients.


Balas, M. C., Weinhouse, G. L., Denehy, L., Chanques, G., Rochwerg, B., Misak, C. J., Skrobik, Y., Devlin, J. W., & Fraser, G. L. (2018). Interpreting and Implementing the 2018 Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption Clinical Practice Guideline. Critical care medicine, 46(9), 1464–1470. https://doi.org/10.1097/CCM.0000000000003307

Barcellos, R. de A., Pires, M. Q., Cavalcanti, T. de C., Schimitz, T. dos S. D., Moretti, M. M. S., Azzolin, K. de O., & Haas, J. S. (2020). Risk factors and good practices in delirium management: understanding the nursing team. Research, Society and Development, 9(8), e436985784. https://doi.org/10.33448/rsd-v9i8.5784

BRASIL. Ministério da Saúde. Agência Nacional de Vigilância Sanitária (ANVISA). Resolução da Diretoria Colegiada nº 7, de 24 de fev de 2010. Dispõe sobre os requisitos mínimos para funcionamento de unidades de terapia intensiva e dá outras providências. Diário Oficial da União 25 fev 2010. Disponível: https://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2010/res0007_24_02_2010.html#:~:text=Disp%C3%B5e%20sobre%20os%20requisitos%20m%C3%ADnimos,o%20inciso%20IV%20do%20Art.

Burry, LD, Cheng, W., Williamson, DR et al. (2021). Intervenções farmacológicas e não farmacológicas para prevenir delirium em pacientes críticos: uma revisão sistemática e metanálise em rede. Cuidados Intensivos Med 47, 943-960. https://doi.org/10.1007/s00134-021-06490-3

Cavallazzi, R., Saad, M., & Marik, P. E. (2012). Delirium in the ICU: an overview. Annals of intensive care, 2(1), 49. https://doi.org/10.1186/2110-5820-2-49

Chen, T. J., Chung, Y. W., Chang, H. R., Chen, P. Y., Wu, C. R., Hsieh, S. H., & Chiu, H. Y. (2021). Diagnostic accuracy of the CAM-ICU and ICDSC in detecting intensive care unit delirium: A bivariate meta-analysis. International journal of nursing studies, 113, 103782. https://doi.org/10.1016/j.ijnurstu.2020.103782

Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C., van den Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X., Fraser, G. L., Harris, J. E., Joffe, A. M., … Alhazzani, W. (2018). Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical care medicine, 46(9), 1532–1548. https://doi.org/10.1097/CCM.0000000000003259

Ely, E. W., Margolin, R., Francis, J., May, L., Truman, B., Dittus, R., Speroff, T., Gautam, S., Bernard, G. R., & Inouye, S. K. (2001). Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Critical care medicine, 29(7), 1370–1379. https://doi.org/10.1097/00003246-200107000-00012

Eskioglou, E., Iaquaniello, C., Alvarez, V., Rüegg, S., Schindler, K., Rossetti, A. O., & Oddo, M. (2021). Electroencephalography of mechanically ventilated patients at high risk of delirium. Acta neurologica Scandinavica, 144(3), 296–302. https://doi.org/10.1111/ane.13447

Favre, E., Bernini, A., Morelli, P., Pasquier, J., Miroz, J. P., Abed-Maillard, S., Ben-Hamouda, N., & Oddo, M. (2020). Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients. Critical care (London, England), 24(1), 66. https://doi.org/10.1186/s13054-020-2796-

Girard, T. D., Pandharipande, P. P., & Ely, E. W. (2008). Delirium in the intensive care unit. Critical care (London, England), 12 Suppl 3(Suppl 3), S3. https://doi.org/10.1186/cc6149

Hsieh, S. J., Soto, G. J., Hope, A. A., Ponea, A., & Gong, M. N. (2015). The association between acute respiratory distress syndrome, delirium, and in-hospital mortality in intensive care unit patients. American journal of respiratory and critical care medicine, 191(1), 71–78. https://doi.org/10.1164/rccm.201409-1690OC

Jiang, X., Shen, Y., Fang, Q., Zhang, W., & Cheng, X. (2020). Platelet-to-lymphocyte ratio as a predictive index for delirium in critically ill patients: A retrospective observational study. Medicine, 99(43), e22884. https://doi.org/10.1097/MD.0000000000022884

Khan, B. A., Perkins, A. J., Gao, S., Hui, S. L., Campbell, N. L., Farber, M. O., Chlan, L. L., & Boustani, M. A. (2017). The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU. Critical care medicine, 45(5), 851–857. https://doi.org/10.1097/CCM.0000000000002368

Krewulak, K. D., Rosgen, B. K., Ely, E. W., Stelfox, H. T., & Fiest, K. M. (2020). The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients. PloS one, 15(11), e0242378. https://doi.org/10.1371/journal.pone.0242378

Leite, M. A., Osaku, E. F., Costa, C. R., Cândia, M. F., Toccolini, B., Covatti, C., Costa, N. L., Nogueira, S. T., Ogasawara, S. M., de Albuquerque, C. E., Pilatti, C. M., Piana, P. A., Jorge, A. C., & Duarte, P. A. (2014). Delirium during Weaning from Mechanical Ventilation. Critical care research and practice, 2014, 546349. https://doi.org/10.1155/2014/546349

Mansouri, P., Javadpour, S., Zand, F., Ghodsbin, F., Sabetian, G., Masjedi, M., & Tabatabaee, H. R. (2013). Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: a randomized clinical trial. Journal of critical care, 28(6), 918–922. https://doi.org/10.1016/j.jcrc.2013.06.019

Mart, M. F., Williams Roberson, S., Salas, B., Pandharipande, P. P., & Ely, E. W. (2021). Prevention and Management of Delirium in the Intensive Care Unit. Seminars in respiratory and critical care medicine, 42(1), 112–126. https://doi.org/10.1055/s-0040-1710572

Mehta, S., Cook, D., Devlin, J. W., Skrobik, Y., Meade, M., Fergusson, D., Herridge, M., Steinberg, M., Granton, J., Ferguson, N., Tanios, M., Dodek, P., Fowler, R., Burns, K., Jacka, M., Olafson, K., Mallick, R., Reynolds, S., Keenan, S., Burry, L., … Canadian Critical Care Trials Group (2015). Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Critical care medicine, 43(3), 557–566. https://doi.org/10.1097/CCM.0000000000000727

Nacul, F. E., Paul, N., Spies, C. D., Sechting, H., Hecht, T., Dullinger, J. S., Piper, S. K., Luetz, A., Balzer, F. S., Wernecke, K. D., Sa, A. K., Barros Ferreira da Costa, C., Eymold, L., Chenitir, C., & Weiss, B. (2020). Influence of Sedation Level and Ventilation Status on the Diagnostic Validity of Delirium Screening Tools in the ICU-An International, Prospective, Bi-Center Observational Study (IDeAS). Medicina (Kaunas, Lithuania), 56(8), 411. https://doi.org/10.3390/medicina56080411

Pandharipande, P., Cotton, B. A., Shintani, A., Thompson, J., Pun, B. T., Morris, J. A., Jr, Dittus, R., & Ely, E. W. (2008). Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients. The Journal of trauma, 65(1), 34–41. https://doi.org/10.1097/TA.0b013e31814b2c4d

Patel, M. B., Bednarik, J., Lee, P., Shehabi, Y., Salluh, J. I., Slooter, A. J., Klein, K. E., Skrobik, Y., Morandi, A., Spronk, P. E., Naidech, A. M., Pun, B. T., Bozza, F. A., Marra, A., John, S., Pandharipande, P. P., & Ely, E. W. (2018). Delirium Monitoring in Neurocritically Ill Patients: A Systematic Review. Critical care medicine, 46(11), 1832–1841. https://doi.org/10.1097/CCM.0000000000003349

Reade, M. C., & Finfer, S. (2014). Sedation and delirium in the intensive care unit. The New England journal of medicine, 370(5), 444–454. https://doi.org/10.1056/NEJMra1208705

Santos, M. R. S., Silva, M. J. R. B., Dias, G. de N. e S., Guimarães, D. C., Soares, L. V. A., Simor, A., Araújo, A. B. M. de, Dias, B. R. L., & Carmo, B. K. O. do . (2021). Length of stay reduction in Intensive Care Unit associated with nursing care: Integrative literature review. Research, Society and Development, 10(7), e49010716781. https://doi.org/10.33448/rsd-v10i7.16781

Schubert, M., Bettex, D., Steiger, P., Schürch, R., Haller, A., Bogdanovic, J., Garcia Nuñez, D., Schwarz, U., & Siegemund, M. (2020). Implementation of a multiprofessional, multicomponent delirium management guideline in two intensive care units, and its effect on patient outcomes and nurse workload: a pre-post design retrospective cohort study. Swiss medical weekly, 150, w20185. https://doi.org/10.4414/smw.2020.20185

Souza, M. T., Silva, M. D., & Carvalho, R. (2010). Revisão integrativa: o que é e como fazer. einstein (São Paulo), 8(1), 102-106. https://doi.org/10.1590/s1679-45082010rw1134

Tanaka, L. M. S., et al. (2015) Delirium em pacientes na unidade de terapia intensiva submetidos à ventilação não invasiva: um inquérito multinacional. Revista Brasileira de Terapia Intensiva, 27(4). https://doi.org/10.5935/0103-507X.20150061.

Tomasi, C. D., Grandi, C., Salluh, J., Soares, M., Giombelli, V. R., Cascaes, S., Macedo, R. C., de Souza Constantino, L., Biff, D., Ritter, C., & Dal Pizzol, F. (2012). Comparison of CAM-ICU and ICDSC for the detection of delirium in critically ill patients focusing on relevant clinical outcomes. Journal of critical care, 27(2), 212–217. https://doi.org/10.1016/j.jcrc.2011.05.015

van den Boogaard, M., Schoonhoven, L., van der Hoeven, J. G., van Achterberg, T., & Pickkers, P. (2012). Incidence and short-term consequences of delirium in critically ill patients: A prospective observational cohort study. International journal of nursing studies, 49(7), 775–783. https://doi.org/10.1016/j.ijnurstu.2011.11.016

Weiss, B., Paul, N., Spies, C. D., Ullrich, D., Ansorge, I., Salih, F., Wolf, S., & Luetz, A. (2022). Influence of Patient-Specific Covariates on Test Validity of Two Delirium Screening Instruments in Neurocritical Care Patients (DEMON-ICU). Neurocritical care, 36(2), 452–462. https://doi.org/10.1007/s12028-021-01319-9

Yoshino, Y., Unoki, T., Sakuramoto, H., Ouchi, A., Hoshino, H., Matsuishi, Y., & Mizutani, T. (2021). Association between intensive care unit delirium and delusional memory after critical care in mechanically ventilated patients. Nursing open, 8(3), 1436–1443. https://doi.org/10.1002/nop2.760

Zhang, H., Yuan, J., Chen, Q., Cao, Y., Wang, Z., Lu, W., & Bao, J. (2021). Development and validation of a predictive score for ICU delirium in critically ill patients. BMC anesthesiology, 21(1), 37. https://doi.org/10.1186/s12871-021-01259-z



How to Cite

MINELLA, F. C. O. .; MELLO NETO, S. A. A. de; OSAKU, E. F. .; COSTA, C. R. L. de M.; GIANCURSI, T. Diagnosis of delirium in patients admitted to an Intensive Care Unit: an integrative review. Research, Society and Development, [S. l.], v. 11, n. 10, p. e161111032696, 2022. DOI: 10.33448/rsd-v11i10.32696. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/32696. Acesso em: 3 oct. 2022.



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