Delirium is an under-recognized, highly prevalent form of organ dysfunction in the intensive care unit (ICU). It is imperative to be aware of risk factors for delirium in the ICU, some of which are modifiable. In the last 5 years, a new tool for detecting delirium among critically ill patients has been validated and found reliable for use at the bedside by psychiatrists and nonpsychiatrically trained personnel as well. The tool, the Confusion Assessment Method for the Intensive Care Unit, has enabled determination of the serious sequelae of delirium, including increased mortality, higher cost, longer length of hospital stay, failure of extubation, and burdensome, long-term cognitive impairment. This article reviews prevention and treatment options, and current pharmacologic and nonpharmacologic approaches to delirium, acknowledging limited but improving quality of evidence to date.