Week 4: Delirium in the ICU

Delirium in the ICU isn’t the name of the next big a horror movie, sadly it is a growing problem in ICUs across the nation. According to the article “A Pilot Study on Delirium in the Intensive Care Unit” published in Dimensions Of Critical Care Nursing, delirium is linked to longer hospital stays and a worse prognosis for patients. According to the article in order for us to stop the rapidly growing problem, we need to have an understanding of the types and causes of delirium. There are 3 different types of delirium, which include: hyperactive, hypoactive, and mixed type (Whitcomb et al., 2013). Hyperactive is most recognizable and is characterized by an agitated patient with a hyperactive motor activity (Whitcomb et al., 2013). Second is the most common type of delirium hypoactive, which is characterized by lethargic stupor and a depressed consciousness, with no signs of agitation (Whitcomb et al., 2013). Third considered the most dangerous type is mixed delirium, which is a mix of hyperactive and hypoactive, so a patient may quickly switch from a lethargic stupor to a frightening state of agitation (Whitcomb et al., 2013). The article also pointed out that the main causes of delirium maybe connected to sleep deprivation and a heavy use of sedatives.

The study focused on a possible correlation between insufficient sleep and the development of delirium. The study also aimed to identify other environmental causes contributing to delirium. This pilot study, studied seven different patients, for seven nights, ages 65 and older, all which were intubated and sedated. The study found that between the hours of 9pm and 6am on average 48% of the patients remained awake, 30% were in a light sleep, only 18.5% were in REM, and 3.4% were in a deep sleep. I found it very interesting that they found that one patient had remained awake for 58-88% during his entire hospital stay. After reviewing the findings of the article I definitely agree that there is a relationship between a lack of REM sleep, sedation, and delirium. I realize that if patients aren’t getting proper rest, they will not be able to heal properly. Sleep deprivation in combination with sedation, and the development of delirium needs to be further investigated in my opinion. It would be interesting to see if with improved quality of sleep if delirium levels would decrease.

 

Reference:

Whitman, J. J., Morgan, M., Irvin, T., Spencer, K., Boynton, L., Turman, S., & Rhodes, C. (2013). A pilot study on delirium in the intensive care unit. Dimensions of Critical Care Nursing, 32(5), 266-270. doi:10.1097/DCC.0b013e3182a077cd