The importance of early recognition and timely treatment of delirium in intensive care units

Abstract

Delirium is connected to bad short-term (the increase in hospital mortality rate and hospital days) and long-term outcomes (disfunctionality, institutionalisation, cognitive damage and post hospital-release dementia). The objective of this study is to determine whether there are possible incompatibilities of treatment of delirium with the recommendations in the guides of good clinical practice from developed countries. The grounded method was used in the study. The so called principal sampling of 17 psychiatrists, anesthesiologists and registered nurses was conducted. Afterwards, the unstructured interviews with the selectees were conducted, transcribed and analyzed immediately through coding, category and concept detection. Having completed this, the theoretical sampling of new interview examinees was conducted. Their analysis enabled the concepts to be linked into a working theory and graphically displayed. The new sampling, the new interviews and their analysis were then continued interactively until the saturation of the working theory was achieved and the final version of the theory was formulated based on the findings reached through the interviews. Having completed the principal sampling and coding of the transcripts led the researches to the saturation of the theory through the separation of eight categories: A -Delirium as a sign of system infection, B -Therapy -Anaesthesiologists administer benzodiazepines, whereas psychiatrists administer antipsychotics, C -An inconspicuous onset of delirium is overlooked, D -Bleeding as the cause of delirium, E -Anticholinergics as a cause of delirium, F -Misunderstanding the nature of delirium by anaesthesiologists, G -Being aware that the patient is vitally endangered, and H -The nurses apply enhanced health care measures. Delirium is a syndrome which can be prevented in 30-40% of cases (50). An etiological treatment would help avoid complicating delirium's clinical picture and would very much prevent poor outcomes, such as institutionalisation, cognitive damage and delirious patients' high mortality rate.