Prevention and Management of Patients with Delirium during Hospitalization: Hospital Protocol

Abstract

Delirium is a syndrome of acute onset and potentially reversible course, characterized by disturbances across multiple cognitive domains. It has a high prevalence, particularly among the elderly population, affecting more than 50% of patients in the hospital setting. Therefore, the authors consider it essential to conduct an in-depth analysis of this condition, as well as to define structured strategies for prevention, early diagnosis, and appropriate management.

An extensive literature review was conducted, including original articles, systematic reviews, clinical guidelines, and institutional documents. For this purpose, the PubMed and Google Scholar databases were searched, along with clinical reference platforms such as UpToDate and Medscape. Additionally, guidelines published by the National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network (SIGN), and the American Geriatrics Society (AGS) were reviewed.

Available evidence demonstrates that the cornerstone of delirium management is the implementation of non-pharmacological strategies focused on prevention, particularly those aimed at enhancing orientation, promoting environmental familiarity, and regulating the sleep–wake cycle. Pharmacological therapy should be reserved for cases of hyperactive delirium, with haloperidol being the most extensively studied agent in this class. However, there has been a growing use of atypical antipsychotics, such as quetiapine, risperidone, olanzapine, and aripiprazole. In patients with disruption of the sleep–wake cycle, treatment should focus on its normalization, favoring the use of agents approved for insomnia, such as trazodone, mirtazapine, and melatonin.

It should be emphasized that physical restraint must be considered an exceptional measure, justified only when there is a risk to the physical integrity of the patient or others, and only after all other therapeutic options have been exhausted.

In summary, this protocol is expected to contribute to improving the clinical approach to delirium by promoting its prevention, early recognition, and appropriate management, thereby reducing morbidity, length of hospital stays, and associated healthcare costs, as well as fostering the standardization of evidence-based practices.