What are your go-to options for managing ICU delirium in patients with contraindications to antipsychotics?  

Evidence for Ramelteon (Yu et al., PMID 36726202)Delirium with behavioral disturbances Depakote Clonidine Propranolol, especially with TBI Non pharmacological Make sure they're closer to the nursing station. Constant re-orientation. Shades open during the day and close at night. Bring anythi...

I think that the question really should be—what are we trying to treat? If the patient is delirious, as noted, the most important task is to identify this as delirium and then treat the underlying cause. If the patient is aggressive/agitated (hyperactive delirium), then the above medication ch...

Precedex unless bradycardic or hypotensive. Depakote may also be helpful if LFTs are okay. Of course, if delirium is due to alcohol withdrawal, then the CIWA protocol with benzodiazepines.

There are no medications that can predictably shorten the duration of delirium. The drugs that are listed should only be used, in my opinion, for severe agitation, including antipsychotic medication.

I assume the question is directed toward pharmacologic options. In that regard, dexmedetomidine is very helpful and should be considered first-line in the absence of bradycardia or hypotension. Assuming that we are not dealing with delirium secondary to withdrawal, such as alcohol withdrawal, in wh...