Patient handout

Delirium (inpatient/ICU)

PRODUCTION

1. Your condition

This handout is for delirium (inpatient/icu). Your care team identified this based on: acute (hours-days) onset of inattention + fluctuating course (cam core feature; inouye 1990).

Other reasons your team may use this plan: fluctuating level of consciousness or arousal (rass / gcs variation); new agitation or lethargy in elderly inpatient (sccm padis 2018 pmid 30113379); icu patient on sedation with altered mental status — cam-icu positive (sccm padis 2018).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ABCDEF bundle	—	—	—	SCCM PADIS 2018 — Assess + treat pain; Both SAT (spontaneous awakening trial) + SBT (spontaneous breathing trial); Choice of analgesia + sedation (avoid benzo); Delirium assess (CAM-ICU); Early mobility/exercise; Family engagement. Largest evidence base for prevention + reducing duration
HELP bundle (Hospital Elder Life Program)	—	—	—	Inouye Lancet 2014 PMID 21796639 + HELP meta — orientation, sleep hygiene, early mobility, hearing/vision aids, hydration, no restraints, deprescribe; reduces delirium incidence ~40%
Discontinue offending medications	—	—	—	AGS Beers 2023 — taper anticholinergic load (diphenhydramine, oxybutynin, scopolamine, paroxetine, TCAs); reduce benzo; switch sedating antihistamines to non-sedating; switch opioids to multimodal (SCCM PADIS 2018)
Treat precipitant	—	—	—	NICE CG103 + Marcantonio NEJM 2017 PMID 21075055 — single most effective intervention is treating the precipitant; UTI most common in elderly (Inouye Lancet 2014)
Sleep / day-night cycle restoration	—	—	—	SCCM PADIS 2018 — minimise nighttime interventions, dim lights, avoid daytime naps, melatonin 3 mg HS off-label evidence weak
Early mobility / PT/OT	—	—	—	SCCM PADIS 2018 PMID 30113379 — early mobility reduces delirium duration and ICU LOS

Plan: Non-pharm ABCDEF (ICU) + HELP (inpatient non-ICU) — first-line for ALL delirium per SCCM PADIS 2018 PMID 30113379 + Inouye Lancet 2014

3. When to call your provider

Contact your care team if any of the following happen:

Recurrent acute confusion → ED for repeat workup
Persistent cognitive decline → outpatient dementia workup (symptom.dementia.v1)
PHQ-9 ≥15 OR suicidal ideation → urgent psych referral
Falls recurring → comprehensive fall prevention + home safety
Caregiver burnout → respite + adult protective services if concerns

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

CAM-ICU positive in ventilated / non-verbal ICU patient — Ely 2001 Crit Care Med original; SCCM PADIS 2018 standard
Delirium superimposed on pre-existing dementia (DSD) — both diagnoses present; CAM positive against known cognitive baseline (Marcantonio NEJM 2017 PMID 21075055)
Alcohol-withdrawal delirium (DTs) — autonomic instability + tremor + hallucinations + tachycardia + diaphoresis 72-96 h after last drink; CIWA-Ar ≥15 (NICE CG100; ASAM 2020)(life-threatening)
Benzodiazepine or opioid withdrawal precipitating delirium — abrupt discontinuation in chronic user (COWS for opioid, CIWA-B for benzo)
Metabolic-induced delirium — hyponatremia (<125), hypernatremia (>155), hypoglycemia (<70), uremia (BUN >100 or Cr >5), hypercapnia (PCO2 >60), hepatic encephalopathy (ammonia >100), hypercalcemia (>13)
Sepsis-associated encephalopathy (SAE) — delirium with concurrent infection meeting qSOFA ≥2 or Sepsis-3 criteria; cytokine-driven CNS dysfunction (Surviving Sepsis 2026)(life-threatening)

5. Follow-up

Post-discharge cognitive follow-up (≥30% of post-ICU delirium patients have long-term cognitive impairment per BRAIN-ICU); medication reconciliation; geriatric clinic if persistent cognitive complaints; ACP / driving discussion (Inouye Lancet 2014 PMID 21796639)

6. Sources

Guideline: 2018 SCCM PADIS Guidelines + 2019 NICE CG103 Delirium + AGS Beers 2023 + APA 2024 BPSD + 2026 Surviving Sepsis (for SAE)