Week 4 Discussion: ICU Delirium
Hello all!
I think that topics related to ICU such as ventilators, sedation, safety, and ICU delirium are all very interesting. I wanted to explore the effects of sedation medications on patients in the ICU. The question I had is if there was a reduction of sedation medication administered to ICU patient would there be a decrease in ICU delirium overall?
There were a couple articles I found that related to the about my subject of interest about effects of sedation medications on patients in the ICU. In the article, Fluctuations in sedation levels may contribute to delirium in ICU patients, the authors, Svenningsen, Egerod, Videbech, Christensen, Frydenberg, and Tønnesen (2013), conducted a prospective study of adult patients at three multidisciplinary ICU with an aim to investigate the impact of fluctuating sedation levels on the occurrence of delirium in the ICU, (p.228). The authors addressed that delirium is a serious complication for patient in the ICU and could possibly increase mortality and morbidity, (Svenningsen, Egerod, Videbech, Christensen, Frydenberg, and Tønnesen, 2013, p.228). Svenningsen et al. (2013), went onto emphasis orthodox treatment of ventilated ICU patient involves deep sedation with the goal to reduce anxiety, pain, and stress but in the past decade treatments have shifted and more focus is now on moving away from deep sedation because it has been proven “…daily interruption of continuous intravenous infusions of sedatives decreased the duration of mechanical ventilation, length of ICU stay, and length of hospital stay”, (p.228). In the study, Svenningsen et al. (2013) used the Confusion Assessment Method for the ICU (CAM-ICU) which is a tool used to assess presence of delirium among patients in the ICU and the authors used the CAM-ICU which they detected results of hypoactive, hyperactive, and mixed-type delirium, (p.228 & 292). Additionally, the authors concluded that, “…dosage, administration, timing, and choice of sedative agent may potentially influence delirium status in ICU patients”, (Svenningsen et al., 2013, p.292). Overall there are a lot of factors that can cause ICU delirium in patients, which can increase the length of stay and possibly the mortality rate for ICU patients but by utilizing the new treatmentss of reducing sedation levels in ICU patient or even stopping sedative agents the risk of developing delirium can be greatly reduced and better outcomes for patients can be achieved.
Furthermore, another example of new treatment for ICU patient was seen in the video, Patients and Aging Brain Problems, where Dr. Wes Ely discussed about how a team of physicians, which including himself got funding for a study so they could do a multicenter investigation where they called it the “ABC” approach or the awakening, breathing, control trial. What they were essentially doing is waking patients up, seeing if they can breath, and then liberating them from the life support. Dr. Wes Ely explained, in the study half the patients got a standard approach where their drugs were targeted to the exact level the doctors and nurses thought they should be and the other half of the patients got that targeted drugs regimen but on top of that they overlaid a mandatory rule that as long as some safety criteria were met they stop the drugs cold everyday. At first staff was a little hesitate to stop the drugs cold everyday but it turned out that they cut the drugs by 50% and there was no increase in pain or bad dreams or awareness of bad memories and despite non of those problems the physicians found a huge difference in length of stay and death rates. Dr. Wes Ely was excited to reveal that the results of the study was the length of stay was four days less in the ICU and the patients were 15% less likely to die.
Lastly, I wanted to share with everyone a video published on October 2, 2012 I found that I believe was informative and also touched on the different types for sedative agents to consider when sedating patient in the ICU. It also talks about how the new idea of sedating patients less has been proven to decrease ICU delirium in patients. The video is from the Expert Commentary Series on Medscape and Dr. Shoor discusses how researchers look at the safety and efficacy of dexmedetomidine vs midazolam or propofol for long-term sedation of mechanically ventilated patients in the ICU. Click on this link to watch the video: http://youtu.be/D27WW0ya-78
In conclusion, I am very interested in this subject of ICU delirium and effects of sedation on ICU patients. I believed I learned a great deal from the articles and video I found about the subject and I hope you too enjoy reading and watching them as much I did. I think that the new treatments of reducing time spent on sedative agents and the ventilator while really increase a patient’s quality of life after their hospitalization in the ICU. In the article, Informed Patient: Changing the Sedation Status Quo in ICU, from the Wall Street Journal’s Health Blog, the author, Laura Landro, also discussed about the new treatments hospital are utilizing in the ICU that consist of decreasing the duration patients spend heavily sedated and on a ventilator. Landro (2011) expressed that this new treatment that includes waking patients from sedation, assessing their pain level, and aspiring to have patients breathe on their own sooner all show that heavily sedated ICU patients often suffer from prolonged delirium that can have devastating and long-lasting effects on cognitive function, (2nd paragraph). As all the articles and videos have answered my questioned and I have learned that the new treatment of reducing time the ICU patient is sedated and on a ventilator the less likely the will have ICU delirium and lasting cognitive dysfunction. I completely agree with this new treatment and am happy to see medicine go in a direction that has the patient’s quality of life post-ICU in mind.
Thank you for reading my post 
Take care, Emily
References
Ely, W. (2013, January 1). ABCDEFs of Prevention and Safety: Patient and Aging Brain Problems. Retrieved January 29, 2015, from http://www.icudelirium.org/
Landro, L. (2011, February 15). Informed Patient: Changing the Sedation Status Quo in the ICU. Retrieved January 29, 2015, from http://blogs.wsj.com/health/2011/02/15/changing-the-sedation-status-quo-in-the-icu/
Sedation in the ICU: Comparing 3 Drugs for Safety, Efficacy. [Video]. (2013). USA: Georgetown University. http://youtu.be/D27WW0ya-78
Svenningsen, H., Egerod, I., Videbech, P., Christensen, D., Frydenberg, M., & Tønnesen, E. (2013). Fluctuations in sedation levels may contribute to delirium in ICU patients. International Journal of Anaesthesiology and Intensive Care, Pain, and Emergency Medicine., 57(3), 288-93. Retrieved January 29, 2015, from CINAHL Plus with Full Text. DOI: http://dx.doi.org.summit.csuci.edu:2048/10.1111/aas.12048
