Delirium in Critical Care is applicable to all practicing anesthesiologists, although it has been written with an emphasis on critical care. Perioperative patient care, including care during the intraoperative period, has an impact on delirium. This book, therefore, contains valuable information for all providers caring for patients at risk of delirium.
The passion of the authors is palpable when reading this book, and theirs is a practical approach. Both had fathers who suffered from delirium during critical illness, thus lending the authors a unique perspective with experience as a family member and as a practicing critical care physician.
This book is comprehensive, covering prevention, recognition, differential diagnoses, and treatment paradigms for delirium. The key emphasis is on the prevention of delirium, including the recognition of those patients with risk factors for the development of delirium. The adage “an ounce of prevention is worth a pound of cure” is clearly applicable to delirium. The 213 pages of text offer many salient points to heighten the awareness of delirium as a form of acute organ failure by characterizing this malady as an “acute episode of brain failure.” This characterization helps to emphasize the seriousness of the disorder because delirium is an independent predictor of mortality, a predictor of long-term cognitive impairment, and it increases the length of stay in both the intensive care unit and the hospital.
This book also covers key points in the care for those at risk of developing delirium, including heightening the awareness of this clinical syndrome that requires a bedside clinical diagnosis, which is often easily missed. A brief history of delirium—with its different names—establishes the long-standing nature of the disorder. Part of the challenge in diagnosing delirium is that the delirious patient most frequently presents with lethargy and an inability to maintain attention (i.e., hypoactive, rather than hyperactive); the hypoactive form is associated with a worse outcome compared with the hyperactive form. The multifactorial nature of the risk factors of this syndrome is discussed, as are baseline patient risk and other precipitating factors and/or insults during hospitalization. Screening tools, especially those applicable to critically ill patients, are discussed in detail, including the importance of ensuring adequate analgesia and sedation to decrease the incidence of delirium. The possible causes of delirium and treatments are covered; all are applicable to anesthesiologists rendering care during the perioperative period. Nonpharmacologic strategies to prevent delirium, including patient orientation, communication, and early mobilization as well as a justified rationale for medication administration, are recommended. Also discussed are the realities of delirious patients lacking capacity and their potential need for physical or chemical restraints for safety.
This book is well written and is a comprehensive guide for the treatment of critically ill patients with delirium. The material is appropriate for anesthesia providers whose care impacts the perioperative period and whose patients have the potential to develop delirium. I highly recommend it for critical care and anesthesia providers so as to heighten their awareness of the seriousness of delirium and to better their understanding of the positive or negative impact that perioperative care can have on this syndrome.