Checklist for Treatment of Delirium in the ICU 


Remove causative factors 
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Exclude hypoglycemia if this is possible 
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Review the medication list and d/c deliriogenic meds if possible. 
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Treat hypernatremia if present. 
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Remove unnecessary invasive devices/tubes & restraints. 
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Consider scheduled acetaminophen if uncontrolled pain or persistent fevers. 
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If Wernicke's encephalopathy possible, empiric thiamine 500 mg IV Q8hr 
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If cirrhotic, consider empiric treatment for hepatic encephalopathy 


Sleep maintenance 
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Scheduled melatonin agonist before sleep (melatonin -•3 mg or ramelteon 8 mg). 
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Earplugs & eye shades at night if tolerated. 
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Avoid unnecessary sleep interruption (e.g. frequent Bp cuff monitoring). 
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If difficulty sleeping, administer pharmacologic therapy early in the night (e.g. quetiapine 50 mg qhs) 


Nocturnal dexmedetomidine 
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May be useful in patients with severe nocturnal agitation, especially if this is refractory to antipsychotic therapy. 
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Use dexmedetomidine at night, titrate to light sleep. 
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Discontinue dexmedetomidine during the day to maintain circadian rhythm. 


Reorientation during the day 
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Use patient's glasses & hearing aides if needed 
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Physical therapy and early mobilization. 


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