Facilitators of Gender-Affirming Medical Care for Transgender and Nonbinary Adolescents.

Delirium is a common and serious complication for patients with critical illness, affecting up to 70% of those admitted to ICU []. As populations age and the number of patients with multiple chronic conditions who require intensive care continues to rise, the incidence of ICU delirium is expected to increase. Clinically, ICU delirium is characterised by acute disturbances in attention, awareness and cognition, often accompanied by hallucinations, disorganised thinking and profound confusion []. These symptoms are distressing for patients and their families and present a significant challenge for ICU staff. The presence of delirium in patients who are critically ill is associated with substantially worse outcomes. Compared with patients without delirium, those affected experience more than a two‐fold increase in both in‐hospital and 6‐month mortality [, , , ], and have an extended duration of hospital stay (largely within the ICU) [, , ]. The mechanism behind worse outcomes is thought to be impaired communication and treatment adherence, creating a cycle of prolonged mechanical ventilation; extended ICU stay; physical deconditioning; and greater risk of complications. Beyond the acute phase, patients who develop ICU delirium are more likely to require hospital or emergency readmission [], and are at increased risk of long‐term cognitive decline [], dementia and post‐traumatic stress disorder [, , , ]. Whilst delirium is prevalent in all acute care settings, there are some features of delirium in the ICU that make its identification, prevention and management different to other areas. The severity of acute illness and need for interventions increases the risk of delirium for a wider age‐group (up to 70% of all admissions in some cohorts []) than in other acute settings, where delirium mainly affects older adults (around 30% of adults aged ≥ 65 y []). In addition, sedative drugs given to patients to tolerate mechanical ventilation can both mask and compound delirium. Further, the ICU environment is noisy day and night, and patients may have multiple machines (e.g. ventilator, renal replacement therapy) and monitoring/therapeutic catheters attached to them. These factors limit sleep, which further compounds delirium.