Nightmares in the ICU ~ Delirium and how to help

Delirium & deep sedation are a HUGE problem in the ICU

delirium

At Hopkins over the weekend, we heard first hand from a patient bravely recalling his experience of delirium while being treated in the ICU and much of what he remembers is terrifying! We learned that 20-80% of ICU patients develop delirium at some point and it is often misdiagnosed or goes unrecognized. However, here is the key:

“Just because something is COMMON, doesn’t mean that it is NORMAL.”

~ Dr. Dale Needham

This is another case where we need to shift our culture and preconceptions about the ICU and realize that while common, delirium can be prevented and when it is we WILL IMPROVE PATIENT OUTCOMES:

  • Delirium has been independently associated with a 2 – 13x increased risk of death
  • Associated with long term cognitive impairment
  • Increases ICU length of stay (8 vs. 5 days)
  • Increases hospital length of stay (21 vs 11 days)
  • Estimated nation costs of $4 to $16 BILLION !

There is good news though, we can help these patients. A randomized controlled trial in 2009 looking at mechanically ventilated critically ill patients who received early physical & occupational therapy showed nearly 50% decrease in days patients suffered from delirium  As well a much quicker return to independent functional status with discharge.

This is a complex issue and I encourage you to explore the resources at the bottom to learn more. But here are some tips to help with the management of of ICU delirium:

Identify and modify risk factors

    • Early mobilization of patients
    • Sedation – MINIMIZE use of benzodiaepines & narcotics
    • Improve sleep  – it is complicated in the ICU but as best as possible allow your patients some quality rest

 

Read more about it, click the article name for links:

Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit  Ely, JAMA 2004; 291: 1753-1762

Early mobilization improves functional outcomes in mechanically ventilated critically ill patients, a randomized controlled trial. Schweikert, Lancet 2009; 373(9678): 1874-1882

There are also many great resources on the Acute Care Section of the APTA: www.acutept.org

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