ABSTRACT
“Sundowning” used to be a common description for a patient suffering from what we describe medically as delirium. Delirium can be considered the most common surgical complication in older adults, with increasing rates after high-risk procedures such as hip fracture repair and cardiac surgery. The BRAIN-intensive care unit (ICU) Study investigators found that of the patients who developed delirium during their hospital stay, 40% had decreased global cognition and executive function at 3 months, and these deficits persisted at 12 months in both younger and older patients. These deficits were similar to patients with moderate traumatic brain injury and mild Alzheimer's disease and independently associated with longer duration of delirium. Management of delirium is rooted in first identifying risk factors and physiologic causes and employing prevention strategies. The Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility bundle incorporates the best available evidence related to delirium prevention in ICU patients.
