Agitation:

• Agitation is a psychomotor disturbance characterized by excessive motor activity associated with a feeling of inner tension.
• In the ICU, agitation is frequently related to anxiety or delirium and may be caused by various factors such as metabolic disorders, hypoxia, use of sedative drugs, sepsis, alcohol withdrawal, and external factors like noise, discomfort, and pain.

Delirium:

• Delirium is a disturbance of consciousness with reduced ability to focus, sustain, or shift attention and can be underdiagnosed in the ICU.
• It can have severe consequences including longer hospital stay, higher costs, increased risk of death, longer-term cognitive decline, and adverse effects on the quality of life in survivors of critical illnesses.

Risk Factors for Agitation and Delirium:

• Risk factors for agitation and delirium include patient factors, iatrogenic or environmental factors, acute illness itself, and medications commonly used in the ICU.
• A thorough approach to the treatment of the acute illness and minimizing iatrogenic factors can reduce the incidence and severity of delirium and its complications.

Prevention and Management:

• Prevention with nonpharmacologic treatment bundles and routine patient assessments is the most effective strategy for reducing the prevalence of delirium in the ICU.
• Appropriate medications and minimizing iatrogenic factors can help in managing agitation and delirium effectively.

Impact of Agitation and Delirium:

• Agitation and delirium are more than just inconveniences and can have deleterious effects on patient and staff safety, contributing to poor outcomes including increased duration of mechanical ventilation, increased ICU length of stay, increased risk of death, physical disability, and long-term cognitive impairment.

Recognizing Agitation and Delirium:

• Clinicians should be able to recognize agitation and delirium and have an organized approach for its evaluation and management to ensure patient and staff safety.

Classification of Delirium:

• Delirium can be classified into hypoactive delirium, hyperactive delirium, or a mixed subtype, with hypoactive delirium being the most prevalent form of delirium.
• Recognition of the different subtypes of delirium is crucial for appropriate management and care of critically ill patients.

Underdiagnosis of Delirium: