Pharmacologic management of integrative brain failure.

Integrative brain failure is often a comorbidity of critical illness, and although not uncommon, is perhaps the least understood of all the various organ failure phenomena. Factors that contribute to integrative brain failure include inadequate management of pain, stress, anxiety, and the several underlying mechanisms that create agitation in the intensive care unit patient. Delirium, a resultant organic mental syndrome, is reversible when promptly recognized and aggressively managed. The nurse who is astute in clinical assessments and skillful in the management of the environment of care can prevent and control states of anxiety, irritability, restlessness, and sleep disturbances that contribute to the development of delirium.