According to the article Delirium in Critically Ill Patients, ICU delirium affects 16-89% of all ICU patients, with the wide range attributed to ineffective delirium assessment on admission, lack of training for the medical staff, and the implementation of different sedation and analgesia protocols (Zaal & Slooter, 2012). Those at a higher risk include the elderly, patients with pre-existing cognitive decline, history of alcohol abuse, sepsis, and immobility.
Although the cause of ICU delirium is unclear, Zaal and Slooter (2012) suggest that an alteration in neurotransmitter activity may be at fault, as patients with ICU delirium show a decrease in acetylcholine activity, resulting in disturbed pathways involving attention, concentration, and learning. Another hypothesis is that delirium is caused by an aberrant stress response, in which the body releases an excess amount of stress hormones that cross the blood-brain barrier, resulting in cognitive impairment (Zaal & Slooter, 2012).
Early screening of ICU patients—with tools such as the intensive care delirium screening checklist (ICDSC) or the confusion assessment method (CAM-ICU)—results in better prognoses for those suffering with delirium. Zaal and Slooter (2012) report that repeated re-orientation, early mobilization, noise reduction, and less interruptions during sleep are effective measures that reduce delirium by 40%. Pharmacologically, intravenous low-dose Haloperidol is the drug of choice, as it has shown to decrease delirium in 23% of ICU patients (Zaal & Slooter, 2012).
Prior to researching this topic, I had no idea ICU delirium existed. However, after reading the articles and watching Anthony Russo’s video, it is clear that more research is needed to not only prevent ICU delirium, but also to effectively treat and provide adequate ongoing psychological help—long after discharge—to those patients in need.
Zaal, I. J., Slooter, A. J. C. (2012). Delirium in critically ill patients: Epidemiology, pathophysiology, diagnosis and management. Drugs, 72(11), 1457-1471. Retrieved from http://eds.a.ebscohost.com.summit.csuci.edu:2048/ehost/detail/detail?