Delirium is a frequently occurring but often under-diagnosed and under-treated problem in the intensive care unit (ICU). It has been linked to adverse outcome, increased length of stay and higher mortality in critically ill patients. A study by Thomason and coworkers published in this issue of Critical Care deals with the issue of delirium and its consequences in less severely ill patients. This commentary aims to provide context for this study, discussing its potential implications as well as the potential therapeutic and preventive measures in patients with hyperactive or hypoactive delirium.