ICU Delirium
I found an article on Medscape Medical News titled, “Establishing Familiar Routines in ICU Reduces Delirium.” It was written by Nancy Melville on January 20, 2015. The article speaks of using daylight control and various cognitive stimulation to reduce delirium in patients. Pamela Smithburger, PharmD, from the University of Pittsburgh School of Pharmacy stated, “We have been practicing some individual components of this approach in the ICU in a somewhat inconsistent manner, but once we protocoled the interventions, we saw a significant decrease in the amount of time patients were delirious.”
A review of the literature on nonpharmacologic interventions for the condition led the researchers to develop a protocol, which they call MORE. It involves blinds to define a number of factors, from circadian balance, sense of day and night, eye and ear care, cognitive stimulation with music, etc. In the study, the researchers evaluated patients in the ICU of a large academic hospital and used a checklist to score findings every 4 hours.
They found that after the implementation of the protocol, there was a decline in the amount of time the patients suffered delirium. Dr Smithburger stated, “We were hoping to see an improvement, and it was indeed significant.” She added, “Psychotropic medications, due to their myriad effects on neurotransmitters, can worsen delirium. In addition, the ICU is a foreign and unfamiliar environment for the patient who is critically ill and often receiving sedative or pain-relieving medications.
I think the article makes a good point. Considering the causes that can lead to delirium and the overall stress that an ICU patient is under, it certainly seems more human, natural and following common sense to address delirium with natural remedies that involved activities and lifestyle patterns that can help resolve the stresses on the patient. Routine can make the “foreign” environment more familiar and friendly.
I think it would be helpful to see further study on this from the scientific standpoint to back up the intuitive agreement with the content. Seeing it in practice would reinforce my opinion. However, for now I think there is a lot of promise in the MORE protocol.
http://www.medscape.com/viewarticle/838409
