Nursing401 ICU Delirium
“Incidence, risk factors and consequences of ICU delirium” discusses the impacts of delirium in the ICU patient (Ouimet, Kavanagh, Gottfried, & Skrobik, 2007). According to this study, 31.8% of patients reviewed suffered from delirium; delirium was linked to increased ICU stay, longer hospitalization, and increased patient mortality. The risk of delirium was increased in patients who received sedatives and analgesics. Delirium was also more highly associated with hypertension, alcoholism, and severity of illness.
It is interesting to note that this article cited a different study that reported delirium in up to 80% of patients. This is significantly higher than the result of this article, which found an occurrence of 31.8%. This demonstrates potential inconsistencies in scoring tools and inclusion/exclusion criteria across various studies.
As an ICU nurse, I find it very frustrating when there is a discrepancy between what evidence-based literature reports and what is practiced clinically. ICU patients are routinely given sedatives and analgesics to manage pain while patients are on highly invasive and painful therapies such as ventilators, balloon pump therapy, hypothermic therapy, etc. Acknowledging the data presented in the articles reviewed for this week’s discussion, I pose the question regarding potential solutions and alternatives to this problem? Yes, of course we want to wean the patient off sedation as soon as possible, but when critical patient warrants such medications, what is the alternative? Is it potential to reduce delirium more beneficial to a patient than managing the risk of extensive pain or self-extubation?
To share a story that happened just this past week, my unit was caring for a post op open heart patient CABG x3 vessels with extensive pulmonary disease. This patient was extremely hemodynamically unstable, on high ventilator support, and extremely agitated. Without going into much more detail, this patient was on two sedative drips, and still his agitation was uncontrolled. This patient ended up pulling out his endotrachael tube and needed to an emergency reintubation. The surgeon was extremely upset and ordered a third sedative for this patient. Knowing the data associated with sedation and delirium, would this order be beneficial to the patient? Lack of adequate sedation led (in part) to the self-extubation from which could have had fatal consequences.
Ouimet, S. , Kavanagh, B. , Gottfried, S. , & Skrobik, Y. (2007). Incidence, risk factors and consequences of icu delirium. Intensive Care Medicine, 33(1), 66-73.
