Neurocritical Care, Sedation & Delirium
Protect the brain, identify reversible changes in consciousness and balance comfort with assessment.
Quick revision ↓ Medical Dictionary
01Assess altered consciousness
Use a structured neurological assessment alongside airway, breathing, circulation and glucose. Review pupils, focal signs, seizures, drugs and the time course. A reduced conscious level may reflect metabolic, toxic, infective or structural disease and requires a cause-focused plan.
02Prevent secondary injury
Hypoxaemia, hypotension, fever and major glucose disturbance can worsen brain injury. Support physiology and obtain urgent specialist advice for suspected intracranial pathology. Positioning and ventilation targets should follow the specific neurological situation and local specialist protocol.
03Recognise seizures
Convulsive status or recurrent seizures without recovery require urgent emergency treatment. Persistent unexplained impaired consciousness can also reflect non-convulsive seizures and may need EEG. Protect the patient from injury and document timing while trained clinicians initiate treatment.
04Target comfort and sedation
Assess pain and prescribe an explicit sedation goal suited to the condition. Deeper sedation is sometimes necessary, but unnecessary depth can delay assessment and recovery. Review analgesia, drug accumulation and opportunities for safe reduction with the team rather than stopping treatment indiscriminately.
05Detect delirium
Delirium is an acute fluctuating disturbance of attention and cognition and may be quiet rather than agitated. Use a validated assessment where suitable and investigate causes. Orientation, sleep support, sensory aids, family involvement and appropriate mobilisation complement correction of physiological and medication triggers.
High-Yield Revision
- Check glucose during assessment of altered consciousness.
- Hypoactive delirium is easily missed.
- Set and review an individual sedation target.
Common Pitfalls
- Assuming every quiet confused patient is simply resting.
- Using sedation to conceal an unexplained deterioration.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 29 September 2026. Consult current local protocols for prescribing, procedures and escalation.