Description
Long stays in ICUs increase the risk of developing ICU psychosis. It is a mental disorder that affects people admitted to intensive care units which typically resolves within a few days to weeks after discharge from the ICU. It is characterized by confusion, disorientation, and delusions. Early recognition and treatment of ICU psychosis can help improve patient outcomes and reduce the risk of long-term complications. Treatment may include reducing the use of sedatives and other medications, providing a calming environment, and using antipsychotic medication.
Summary Listen
- Issue Delirium is a common neuropsychiatric manifestation in ICU patients, particularly those on mechanical ventilation, with incidence rates ranging from 60% to 80%. It is defined as an acute disturbance of consciousness and cognition that fluctuates over time, often precipitated by medical conditions or their treatments. It is considered the sixth vital sign in ICU settings, highlighting its significance.
- The importance of studying and treating ICU delirium stems from its association with increased risks, including aspiration, prolonged ICU and hospital stays, ventilator dependence, ICU-acquired dementia, and a threefold increase in mortality. Risk factors for delirium are categorized as modifiable (environmental factors, acute illnesses) and non-modifiable (age, pre-existing conditions). Severity of illness and age are independent predictors of delirium, with lorazepam use also identified as an independent risk factor.
- Diagnosis of ICU delirium is primarily clinical, relying on assessment of consciousness (rousability and content) using tools like the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the ICU (CAM-ICU). EEG findings may reveal generalized slowing, helping differentiate delirium from delirium tremens.
- Management of ICU delirium involves both pharmacological and non-pharmacological approaches. Pharmacological interventions may include haloperidol, atypical antipsychotics (quetiapine, olanzapine), and dexmedetomidine. Non-pharmacological strategies emphasize orientation, communication, familiar objects, consistent nursing staff, and optimizing the environment for sleep and reducing noise.
- Prevention strategies focus on pain management, early mobilization, improving sleep hygiene, and optimizing pharmacological interventions. The ABCDEF bundle (Assess, prevent, and manage pain; Both SAT and SBT; Choice of analgesia and sedation; Delirium assess, prevent and manage; Early mobility and exercise; Family engagement and empowerment) provides a structured approach.
- The PADIS guidelines recommend using validated tools to assess pain, agitation, and delirium. Light sedation is preferred over deep sedation to minimize the risks of PTSD, depression, and delirium. While propofol and dexmedetomidine are favored over benzodiazepines for sedation, haloperidol and other antipsychotics are not recommended for routine prevention of delirium. Rehabilitation and mobilization are crucial aspects of care, with specific criteria for initiation and cessation.
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