Week 4 Blog Post: ICU Delirium

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This journal article is a study of incidence in delirium in Denmark ICU vent patients 18 years old and older that stayed in the ICU longer than 48 hours. The aim of the study is to investigate the effects of fluctuating levels of sedation on the incidence of delirium in the ICU. They found out that the bigger the changes to the levels of sedation, the is higher chances of the patient having delirium. The article studied 640 patients. In those 640, 65% of them had an incidence of delirium at least once. According to the article, &  Delirious patients were significantly older, more critically ill, more often intubated, had longer ICU stays, and had higher ICU mortality than non-delirious patients& (Svenningsen et. al, 2013).  I agree with the findings of this research. I would imagine that older adult patients will have a higher incidence of ICU delirium because of their age. I feel other patients have incidences due to over medication and longer stay in ICU. The article recommends a systematic delirium assessment tool to prevent, predict, and treat ICU delirium. It also recommended that further studies should  be done between the compounding effects of medication and incidences of delirium.

 

Svenningsen, H., Egerod, I., Videbech, P., Christensen, D., Frydenberg, M., & Tønnesen, E. (2013). Fluctuations in sedation levels may contribute to delirium in ICU patients. Acta Anaesthesiologica Scandinavica, 57(3), 288-293. doi:10.1111/aas.12048

ICU Delirium (week 4)

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I found the video by the ICU delirium and cognitive impairment study group to be very touching. Dr. Wes Ely talks about how geriatrics need advocates in the critical care unit (CCU) and intensive care units (ICU). This topic is very interesting for me because I work in an ICU step-down unit with patients on ventilators .He noted that the patients were leaving these units with worsening cognitive effects that he called an “acquired dementia” from the sedatives they were receiving in the CCU or ICU. This is the first time that I had ever heard about oversedating patients into a delirium to the point where they were having residual cognitive defects after discharge. This prompted me to do some research of my own on ICU delirium. I really loved that he said that he was trying to improve the lives of people he will never meet.  I guess that is what medical research is all about .

I was able to find an article written by a nurse in a Health Science article. In the article named, Delirium: a distressing and disturbing clinical event in a Intensive Care Unit, they talk about tools nurses can use to control the levels of severity of delirium encountered in critical care units. The article found that if tools to classify the severity of delirium were more readily available to nurses, we would be able to identify patients who are at the highest risk for adverse outcomes from sedation medications. I think this a perfect step towards reducing this problem found in the critical care units.

“Several studies have now confirmed that delirium occurs in 60% to 80% of mechanically ventilated patients.” (Maniou , 2012) This number is astonishingly large and something must be done to help these patients. I strongly agree with this article because I think that nurses, as patient advocates, must do something to help stop this. This article offers many screening tools and interventions a nurse can use to help prevent ICU delirium. This includes things such as the Confusion Assessment Method – Intensive Care Unit (CAM-ICU) and using the patient’s glasses and/or hearing aids to help prevent sensory deprivation. Overall, I learned a lot about this topic that I knew little about and I hope that I can bring something back to help care for my patients at work.

Maniou, M. (2012). Delirium: a distressing and disturbing clinical event in a Intensive Care Unit. Health Science Journal, 6(4), 587-597.

 

Introduction

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Hi, my name is Ramir De Castro, but you can call me R.J. for short. I graduated with my ADN  in 2012 in Pasadena City College. I started my health care career as a Surgical Tech in an outpatient surgery center. I then became an LVN and worked in Los Angeles Community Hospital in med-surg/Tele floors for 3 years. I am now working in Sherman Oaks Hospital in Van Nuys. I was hired in 2013 as an ER nurse. I then transferred to MS/Tele. Then to DOU. Now I am recently in the ICU unit. I plan to continue with my education and hopefully get into a BSN to DNP program.