If you have ever had a friend or relative in the intensive care unit (ICU) of any hospital you almost certainly observed the patient having some confusion, especially if they were on ventilator support or unconscious for any length of time. Disturbance in attention, awareness, or thinking is the definition of delirium. These symptoms may fluctuate from day to day and with different times of the day.
Studies on delirium suggest that it is a product of the treatments we give to our patients, particularly in the ICU. Delirium in the ICU is now recognized as a serious consequence. Patients with delirium are 3 times more likely to need re-intubation and ventilator support, experience an increased length of stay of 10 days, and have a 10% increased risk of death. Prolonged hospitalization is associated with a much greater loss of physical abilities and the need for post hospital rehabilitation. Many patients never recover adequately and often need to be referred to skilled nursing facilities or personal care homes.
Unfortunately, there are no known pharmacologic treatments which will prevent or control delirium. Many drugs that are used for sedation or pain management actually cause or increase the risk of delirium. Preventing delirium requires the help of nurses, family, and other care givers. Allowing the patient to get an adequate amount of sleep, removal of catheters and physical restraints, returning the patient’s eye glasses or hearing aids, and reorienting the patient to time, date and surrounding throughout the day, can help prevent and treat hospital associated delirium.