The future of intensive care: delirium should no longer be an issue

Delirium is a condition of acute disturbance in attention and awareness along with disturbances in cognition. It is a symptom of deranged homeostasis and an early sign of infection or hypoxia. The occurrence of COVID-19 brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to several organizational issues like lack of personnel, increased use of benzodiazepines and restricted family visitation.

For the future development of an ideal intensive care unit (ICU) it is important to make the patients free from delirium. As delirium is associated with worse ICU-related outcomes and long-term cognitive impairment in critical illnesses. 

Screening for delirium requires limited time and effort. Completing good sedation practices by novel ICU design and connectivity will facilitate non-pharmacological sedation, anxiolysis and comfort which can further be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can also facilitate a healing environment which would eventually minimize stressors and aid delirium prevention and management. 

The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A–F) bundle. Moreover, gaining (G) insight into patient needs, delivering holistic care with a ‘home-like’ (H) environment, and redefining ICU architectural design (I). 

The most important thing is to obtain a delirium-free world. It requires optimization of design of ICU, environmental factors, management, time spent with the patient and family by the criticare teams during their routine ICU care. 

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