NRS401: Week 4 – Sedation Level Linked to Delirium in ICU

The use of sedatives in patients within ICU’s has been used to decrease anxiety, reduce pain, and relieve any stress to help in the healing process of patients. It has been found that a long amount of time spent under sedation can have acute delirium effects and in some cases more long term effects. Currently, the use of daily interruptions of sedation, also known as sedation vacation, is being practiced to help in lowering the length of mechanical ventilation, length of ICU stay, and length in hospital stay (Svenningsen et al., 2013). In a study done by Svenningsen et al. (2013), the researchers explored the idea that high fluctuation levels in sedation could lead to delirium in ICU patients. Their study included 640 patients over two years in two hospitals. To assess the patient’s levels of sedation and delirium, the Richmond Agitation and Sedation Scale (RASS) and the Confusion Assessment Method for the ICU (CAM-ICU) tools were used. The researchers found that there was a “significant association between major changes in sedation level and incidence of delirium” (Svenningsen et al., 2013).

I feel that this article does make a good point about how the patient’s levels of sedation are correlated to the effects of delirium. To me, it makes sense. If a patient is heavily sedated, when they wake up, wouldn’t they have some level of delirium? There are some limitations within this study that could potentially make a difference such as assessing the patient’s pain level. But I liked how they utilized two tools to measure the levels of sedation and delirium which helped in determining the different degrees of sedation (ie. hypoactive, hyperactive, and mixed delirium). More studies are needed to determine if a set amount of dosing time, type of medication being used, or the amount of the medication increase the effects of the delirium. After reading this article, I now feel that if we continuously monitor the sedation level that the patient is experiencing throughout the day and are able to adjust the amount of sedatives given based on those levels, the onset of delirium will drop.

Reference

Svenningsen H Egerod I Videbech P Christensen D Frydenberg M Tonnesen E 2013 Fluctuations in sedation levels may contribute to delirium in ICU patients.Svenningsen, H., Egerod, I., Videbech, P., Christensen, D., Frydenberg, M., & Tonnesen, E. (2013). Fluctuations in sedation levels may contribute to delirium in ICU patients. Acta Anaesthesiologica Scandinavica, 57(3), 288-293.  201501281916161677993059