Flumazenil for Hypoactive Delirium Secondary to Benzodiazepine Exposure

Inclusion Criteria: * critically ill adults * RASS score of -3 to 0 after receiving benzodiazepine therapy * CAM-ICU positive * no benzodiazepine therapy within the previous 12 hours Exclusion Criteria: 1. contraindications to flumazenil including hypersensitivity 2. receipt of benzodiazepines for control of potentially life-threatening conditions (e.g., control of intracranial pressure or status epilepticus) 3. active seizure disorder or on current anti-convulsant therapy for history of seizure disorder. Seizures secondary to alcohol withdrawal will NOT be excluded. 4. history of traumatic brain injury complicated by seizures 5. acute episode (within prior 30 days) of severe traumatic brain injury 6. history of structural lesion (e.g. subarachnoid hemorrhage, cerebrovascular accident, intra-parenchymal hemorrhage) complicated by seizures 7. acute episode (within prior 14 days) of structural lesion (e.g. subarachnoid hemorrhage, cerebrovascular accident, intra-parenchymal hemorrhage) 8. brain tumor complicated by seizure 9. history of anoxic brain injury 10. third-degree burn with total body surface area (TBSA) burn greater than 20% 11. chronic benzodiazepine (clonazepam:lorazepam:diazepam approximately 4:8:40 mg per day) for 7 consecutive days with no taper 12. chronic delirium that is attributable to other causes 13. anticipated to transfer to lower level of care within 24 hours 14. admitted for polysubstance overdose as determined by initial drug toxicity screening 15. recent exposure (prior 7 days) to pro-convulsant medications (identified via medication list, medication reconciliation performed by PI/pharmacy medication reconciliation team, or urine drug screening) 16. children, incarcerated individuals, and pregnant women 17. unable to provide consent and the legally authorized representative is unable to provide consent