Fact or Fallacy: Risk of Delirium with Benzodiazepines in Critically Ill Adult Patients
by Meagan Macalalag, PharmD, Jeffrey Fish, PharmD, BCCCP, FCCM
Question: What is the risk of delirium with benzodiazepines in critically ill adult patients?
Delirium is a common and serious complication of critical illness, associated with prolonged hospitalization and long-term cognitive impairment. Benzodiazepines have long been identified as a potentially modifiable risk factor for ICU delirium, leading to guideline recommendations that favor non-benzodiazepine sedatives for many mechanically ventilated patients.
This article critically evaluates the evidence behind the presumed relationship between benzodiazepine exposure and delirium in critically ill adults. While observational studies and select randomized trials suggest an association, the authors highlight important limitations related to sedation depth, timing and frequency of delirium assessments, crossover between treatment groups, and the difficulty of separating residual sedation from delirium. Current evidence does not establish a strong causal relationship between benzodiazepines and delirium. Non-benzodiazepine sedatives remain a reasonable first-line approach for many mechanically ventilated patients, but benzodiazepines may still have an appropriate role in select clinical situations, including anxiety, alcohol withdrawal, and seizure management.
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2026 July/August Table of Contents
Question: What is the risk of delirium with benzodiazepines in critically ill adult patients?
Delirium is a common and serious complication of critical illness, associated with prolonged hospitalization and long-term cognitive impairment. Benzodiazepines have long been identified as a potentially modifiable risk factor for ICU delirium, leading to guideline recommendations that favor non-benzodiazepine sedatives for many mechanically ventilated patients.
This article critically evaluates the evidence behind the presumed relationship between benzodiazepine exposure and delirium in critically ill adults. While observational studies and select randomized trials suggest an association, the authors highlight important limitations related to sedation depth, timing and frequency of delirium assessments, crossover between treatment groups, and the difficulty of separating residual sedation from delirium. Current evidence does not establish a strong causal relationship between benzodiazepines and delirium. Non-benzodiazepine sedatives remain a reasonable first-line approach for many mechanically ventilated patients, but benzodiazepines may still have an appropriate role in select clinical situations, including anxiety, alcohol withdrawal, and seizure management.
Download PDF
2026 July/August Table of Contents