Almost two-thirds of ICU patients become confused during their ICU stay, and 7 out of 10 patients on a ventilator become confused. This is often due to a combination of how seriously ill they are and the medications they may receive to treat pain and anxiety. As a result, patients may be awake all night and sleep during the day, forget where they are, or not recognize loved ones. This confusion is known as “delirium.”

Delirium is not the same thing as dementia. While dementia steadily worsens over months and years, delirium comes and goes. Patients with delirium may have periods of time when they are fully awake, aware, and able to understand what is going on, but these are interrupted by periods when they are confused, agitated, and inattentive. While delirium can take days or even weeks to improve, dementia is permanent and irreversible. Delirium can affect both young and old patients, although older patients are at higher risk of developing delirium.

The best way to treat delirium is not with medications but rather by changing the environment. Family and friends can help by staying with the patient during the day, keeping them engaged and awake, opening blinds, reminding them where they are when they become confused, and encouraging them to participate in daily exercise and physical therapy (see next section, “Daily Exercise and Rehabilitation”). If visiting at night, family and friends can ask nurses to turn off unnecessary lights, close blinds, and minimize noise by turning off the television. They can ask if blood draws and x-rays can be rescheduled to minimize interruptions during the night. These changes in environment allowed one hospital in Denmark to stop sedation in some patients and decrease their ICU stay by almost two days.

Despite best efforts, sometimes patients will still require medications to keep them calm. The medical team’s goal is to use these medications at their lowest doses.