Prior to discussion assignment, I was not aware of the condition know as ICU delirium. Watching the videos and researching articles gave me a better understanding of this condition associated with negative outcomes.
In the article, Preventing Delirium in the Intensive Care Unit, delirium in the ICU is characterized as acute organ dysfunction, which then manifest to both consciousness and cognitive disturbances and affects approximately 60-80% of ventilated patients and 20-50% on non-ventilated patients (Brummel & Girard, 2013). Risk factors for delirium in the ICU setting are sedatives, immobility, and sleep disturbances. Since, delirium is a multifactorial, a bundled approach known as the ABCDE approach has been proposed in preventing and reducing the duration of delirium (Brummel & Girard, 2013). This approach utilizes the Awakening and Breathing Coordination, Choice of sedatives, Delirium management, and Early mobility and Exercise components. Implementing these components has with positive improvements of outcomes, which include a decrease in the duration of mechanical ventilation, shorter length of stay in the ICU and hospital, and prevented adverse effects associated with critical illnesses, which can lead to delirium (Brummel & Girard, 2013).
Awakening and Breathing Coordination:
This component utilizes the ABC trial. This includes daily awakening trails that are coordinated with daily spontaneous breathing trials. This strategy has been shown to decrease the duration of brain dysfunction, patients were extubated 3 days sooner, discharged 4 days earlier from the hospital then the patients who received usual care, and a 14 % decrease in mortality rates (Brummel & Girard, 2013).
Choice of sedative:
There were three trials (MENDS, SEDCOM, MIDEX) which showed positive results when utilizing dexmedetomidine as a sedative as oppose to benzodiazepines, versed, and lorazepam. There was a reduction in the development of delirium, and a shorter duration in mechanical ventilation (Brummel & Girard, 2013).
Delirium monitoring and management:
It is important that all clinicians in the ICU setting utilize the CAM-ICU or ICDSC screening tools to monitor their patients. These screening tools assist with alerting the clinicians with identifying reversible and treatable risk factors (e.g. sleep deprivation, dehydration, immobility, visual and hearing impairment) associated with delirium (Brummel & Girard, 2013).
Early Mobility and Exercise:
Early physical rehabilitation resulted in positive outcomes for patients. One study showed that patients who received PT/OT therapy within the 72-hours of being intubated had a reduction in delirium, were discharged from the ICU 2 days earlier and discharged from the hospital 3.5 days earlier than patients receiving usual care (Brummel & Girard, 2013).
Even though, I do not work in the ICU and am not familiar with this common condition, I agree with the strategies this article suggests for the treatment and prevention of Delirium. The ABCDE approach utilizes evidence-based practice strategies that have shown improvement of outcomes associated with critical illness and ICU delirium. I think it is important for researchers to continue to find evidence based strategies that can prevent ICU delirium in patients. Also, it is important for clinicians to identify both modifiable and non modifiable risk factors that can be associated with ICU delirium on admission and include the patient’s family in the care of the patient and listen to their concerns and what they have to say about the patient’s history. Other than the patient, they are the best resource.
Brummel, N. E., & Girard, T. D. (2013). Preventing delirium in the intensive care unit. Critical Care Clinics, 29(1), 51–65. Retrieved from: http://www.ncbi.nlm.nih.gov/articles/PMC3508697/pdf/nihms418369.pdf