Delirium and Dementia in the Intensive Care Unit

Abstract

: Longer stays in the intensive care unit (ICU) can be an opportunistic battlefield where not only is the length of stay longer, but also there is increased time that lapses with the potential for a patient fall, nosocomial infection, urinary tract infection, and other untoward events (http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf; ASHRM Forum. 2014;Q3:10-14). As such, the push has become for shorter lengths of stay whenever possible. Delirium and dementia are 2 conditions that the ICU clinician must remain diligent in monitoring for status changes. Delirium poses the threat of longer-term undesirable outcomes and is a potential inherent risk in the care delivered. It rises to the level of a medical emergency that can be deadly but, when caught early, can be treated and resolved (Science Daily, September 16, 2013). Setting expectations with families, providing adequate education, and involving them in a holistic view of patient-centered care can help toward the detection of differences that may occur from an ICU stay. Interventions the ICU clinician can take for increasing self, patient, and family awareness to decrease risk and improve outcomes and ways to deepen family engagement in these populations are explored with practical applications.

Effect of family reorientation messages on delirium prevention among critically ill patients

“…Patients' related factors might also increase the risk to develop delirium such as severity of illness, age and co-morbidities. [4,7,8] Figure 1. Factors leading to delirium [8] Despite inconsistent prevalence rate of delirium between studies, it is evident that delirium has a negative impact among critically ill patients.…”

“…Evidence shows a relationship between incidence of delirium and short and long term neurocognitive impairments. [7,9] Adverse events associated with delirium in ICUs can range from functional disability, cognitive and psychological impairment, dementia and even death. Removal of invasive lines, self-extubation, prolonged sedation and ventilation therapies which delay the ICU liberation, and increase the overall hospital length of stay are also negative squeals of delirium.…”

“…Removal of invasive lines, self-extubation, prolonged sedation and ventilation therapies which delay the ICU liberation, and increase the overall hospital length of stay are also negative squeals of delirium. [7,9,10] Series of delirium adverse events are not limited to the associated morbidities and mortality, but also extended to include the burden placed on caregivers, families and healthcare services in addition to increase the cost of care. [4,7,11] Realizing the magnitude of delirium sequels for critically ill patients and their families as well as the health care organization would necessitate caregivers, policymakers, and researchers to unravel new era of delirium prevention using non-pharmacological strategies.…”

“…[7,9,10] Series of delirium adverse events are not limited to the associated morbidities and mortality, but also extended to include the burden placed on caregivers, families and healthcare services in addition to increase the cost of care. [4,7,11] Realizing the magnitude of delirium sequels for critically ill patients and their families as well as the health care organization would necessitate caregivers, policymakers, and researchers to unravel new era of delirium prevention using non-pharmacological strategies. Together with early identification of the risk factors, multidisciplinary team work and application of updated evidences would establish definitive outcomes in preventing and treating delirium during the ICU stay to guarantee a better quality of life for critically ill patients post ICU discharge.…”

“…[12][13][14] Since delirium remains unrecognized in most of critically ill patients, vigilant nursing monitoring to assess the risk of delirium as well as the use of valid scales to diagnose delirium such as the Confusion Assessment Method for the ICU (CAM-ICU) are crucial. [7,13,15] Use of evidence-based interventions to prevent delirium should not depend only on an individual physician's order but rather should be structured as a daily part of care with clearly defined safety strategy. [5,13] The delirium prevention bundle is considered an essential intervention of the modern-day processes of care.…”