ICU Delirium

Health Science Journal published an article in 2012 titled “Delirium: a distressing and disturbing clinical event in a Intensive Care Unit.” ContentServer.asp In this article the severity and prevalence of ICU delirium is addressed and its consequential damages and costs.  According to this article, delirium occurs in a very high 60 to 80% of ventilated patients and that there is a 10% increase of death and cognitive disfunction with every day a patient spends in delirium.  Though it is a very real problem, it has yet to be medically recognized and addressed.  The delirium assessment tools available at this time were found to be a challenge to ICU nurses for three reasons: one being it is difficult to assess an intubated patient, second being the inability to assess sedated patients, and third the complexity of the delirium assessment tool.

The article argues that sleep deprivation due to the stressful and often chaotic environment of an ICU as a major factor in which nurses can apply some interventions.  ICU nurses should initiate delirium preventing interventions in most patients but especially those with higher risk factors, such as older age or those with pre-existing cognitive disfunction.  Nurses can also orient the patient to time, place, situation, and also discuss the plan of care as he/she is performing them.  Initiate mobility as soon as possible and provide appropriate aides for patients with sensory deficits (glasses, hearing-aids) during wakeful hours.  Provide adequate nutrition and hydration, and try to perform ADL (Activities of Daily Life) such as hygiene during the appropriate hours.  Lights can also be adjusted during the evening to help orient the patient to night or day time.

The findings from the research are strong enough that future research of delirium prevention and treatment should be stimulated.  And it appears to be the case, for there are people like Dr Ely who is seeing this as a real issue: http://fast.wistia.net/embed/iframe/d257te30h2?popover=true.  However more research and efforts to address this area is needed.  I say this because while searching ICU delirium articles, a majority of the articles that came up in the search were still supportive of heavier sedation, which is shown to likely worsen the risk and severity of delirium.  Nurses implementing interventions within their scope and more research on the very real issue of ICU delirium are the necessary next steps.  As said by Dr Wes Ely, “essentially… medical research is… trying to improve the lives of the people you will never meet.”

References:
“ABCDEFs of Prevention and Safety.” ICU Delirium and Cognitive Impairment Study Group. Web. 29 Jan. 2015. .
Maniou, M. (2012). Delirium: A distressing and disturbing clinical event in a Intensive Care Unit. Health Science Journal, 6(4), 587-597.