A quiet, drowsy patient who is 'resting comfortably' may be delirious. Hypoactive delirium is more common than the agitated form in ICU and on wards, carries at least as poor a prognosis, and is easily mistaken for fatigue, depression or sedation. Use a validated tool such as the CAM-ICU in ventilated patients or the 4AT on the ward, and test inattention specifically — for example, months of the year backwards.
- Screen every critically ill patient for delirium at least once per shift with a validated tool.
- Inattention is the core feature; test it directly.
- A sudden change from baseline alertness counts, even if the patient is calm.
- Search for causes: sepsis, drugs, hypoxia, urinary retention, constipation, pain.
Why it matters
Delirium that is not found cannot be treated, and the quiet form is the one most often missed.
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