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The ABCDE approach to ICU Delirium

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:

Digital technology in healthcare

After reading Digital Trends In Nursing, I was surprised to learn about some of the advancements in healthcare, sensors attached to smartphones that can assess a person’s mental health, academic performance, and behavioral trends, an app dubbed PATRICIA that can assist veterans with PTSD, iPhone’s turned into portable EKG monitors, and ear buds that are not only used to hear music but they also record heart rate, calories burned, total energy expenditure, and maximum oxygen consumption. These are only a few advancements tech companies are currently working on. I read an article that mentioned a digital health company that is located in California and London and is currently developing a sensor for medications that is activated by digestive juices when taken by mouth (Morrissey, 2015). This sensor will be both ingestible and digestible (Morrissey, 2015). After this sensor is activated, it is suppose to transmit information to a skin patch, which then sends the information to an app on a smart phone device (Morrissey, 2015). Healthcare providers can then access this information to see if a person has been compliant with taking their medications (Morrissey, 2015). With the Affordable Care Act and the federal government providing incentives for healthcare providers to go digital; It should be of no surprise that technology is now transforming healthcare (Lee, 2013). Tech companies are now finding ways to make their innovations compatible with smartphones, which the majority of society already owns. Nurses will need to be up-to date with technology in order to properly educate patients on these advancements in a hospital setting, doctor’s office, and at home. In the hospital I work in patients are being taught how to access their health records at home via mobile devices. The plus side to all these innovations is being able to obtain individual data that can help with assessing and properly diagnosing a patient. It all sounds great. These advancements will provide individual patient centered care and I can see an increase of nurses working in home health versus a hospital setting in the near future. Patient’s will no longer need unnecessary test or have to be admitted into a hospital for monitoring that can be done at home using your mobile device. This new technology could help save money in healthcare cost and improve a person’s health by detecting certain diseases early, but at what price? Are they safe? To some degree a person’s privacy will be affected. Someone will have access to every place you go, what you eat and what activities you do. It reminds me of the 1993 movie Demolition Man staring Sylvester Stallone and Sandra Bullock. As I was watching this movie I remember, thinking when will we have this type of technology? It all seemed far-fetched. Now I can see myself utilizing this technology in the near future. All this technology is in the early and experimental stages (Lee, 2013). I don’t believe anyone knows the long terms effects these advancements will have on a person? Only time will tell. Until then many tech companies are will continue to find innovated ways for patients to be monitored at outside the hospital setting with incentives being dollar signs, lowering healthcare cost and making individualized patient centered care.


Lee, E. (2013). 5 ways technology is transforming health care. Forbes.            Retrieved from:

Morrissey, J. (2015). The medical technologies that are changing health care. Hospitals &Health Networks. Retrieved from:  Magazine /2015/Apr/cover-medical-technology