विवरण
Dr Akhlesh Tandelkarr is Senior Registrar in Tata Memorial Hospital,Mumbai. He was Associate Consultant, P.D Hinduja National Hospital, Mumbai, Assistant Professor in Anesthesia and Critical Care, LTMMC and LTMGH, Sion Mumbai, and as Chief Intensivist, Nanavati Super Speciality hospital. He was certified in Honor in Anatomy,Physiology, Medicine and Surgery,and was also awarded for Appreciation for Approach to patient. Has also received an Award for Service to Humanity by Brihanmumbai Corporation of Greater Mumbai. He has also published a Case report on Anesthesia for cases of complicated Hemophilia with Orthopedic emergency.
सारांश
- Delirium is a frequently overlooked yet critical condition in intensive care and emergency medicine, often misconstrued as a mental disorder caused solely by the ICU environment (dubbed "ICU-osis"). Early identification and treatment are vital to reduce hospital stays, treatment costs, and prevent the development of chronic delirium or other physiological disturbances. Clinician understanding of delirium is often lacking, leading to missed diagnoses and delayed interventions.
- Delirium is characterized by a disturbance in consciousness, inattention, and changes in cognition or perception that develop rapidly and fluctuate over time. It's crucial to differentiate it from other psychiatric conditions and use scoring systems like CAM-ICU to aid in diagnosis. Several factors contribute to delirium in the ICU, including prolonged treatment, traumatic procedures, unpleasant experiences, patient anxiety, metabolic disturbances, inadequate sedation, and analgesia.
- Studies show that ICU patients frequently develop delirium, especially those who are severely ill. Unaddressed delirium is linked to increased mortality, prolonged ICU stays, higher sedation use, polypharmacy, and cognitive impairment, potentially leading to dementia. Cognitive performance tests reveal impaired thought organization in delirious patients, highlighting the severity of the condition.
- Hyperactive delirium, though readily noticed and treated, is associated with worse outcomes than hypoactive delirium, which is often overlooked. A structured approach, including assessing for acute changes in mental status, inattention, disorganized thinking, and altered consciousness, is essential for accurate diagnosis. Tools such as the Richmond Agitation-Sedation Scale (RASS) can help monitor sedation levels and identify fluctuations indicative of delirium.
- Managing delirium requires a multifaceted approach, including addressing underlying causes like hypoxia and metabolic disturbances. Non-pharmacological interventions such as improving communication, creating a supportive environment, and involving family members are crucial. Optimizing pharmacological interventions, minimizing polypharmacy, and having a goal-directed approach are also important.
- While antipsychotics like haloperidol and quetiapine are sometimes used, studies have not conclusively shown significant benefits in mortality or length of stay. Quetiapine has demonstrated promise in reducing delirium duration. Pharmacological management should be carefully balanced with non-pharmacological strategies and involve a multidisciplinary team.
- Optimal pain control through adequate analgesia and sedation is crucial for preventing and treating delirium. Analgo-sedation, a strategy combining analgesia and sedation, can minimize the need for excessive sedation. Strategies like daily sedation holidays and spontaneous breathing trials can reduce ventilator days, ICU stays, and associated costs, leading to improved patient outcomes.
- Effective delirium management requires a coordinated effort by physicians, nurses, pharmacists, and social workers. Everyone on the team must follow sedation scoring and adhere to a common goal. Documenting delirium assessment using tools such as the CAM-ICU and following a structured management plan are key to improving patient outcomes in the ICU.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
Dr Aklesh Tandelkar
CRITICAL CARE SPECIALIST MD, EDIC, IDCCM, FIMSA, DA, FCPS, FISCCM
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