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ICU Delirium

By: Kim Maryniak, PhD, RNC-NIC, NEA-BC
ICU Delirium

Delirium is an altered mental status, generally described as confusion, and is usually a transient. Delirium includes difficulty focusing or maintaining attention. Changes in cognition can occur such as memory deficits, disorientation, and perceptual difficulties. Patients in intensive care unit (ICU) settings are at risk for developing delirium, with some studies showing up to 80% of ventilated ICU patients experiencing delirium (Hayhurst, Pandharipande, & Hughes, 2016). Symptoms include clouding of consciousness, disruptions in attention, hallucinations or illusions, changing levels of consciousness, difficulty communicating, motor abnormalities, and tremors (Alagiakrishnan, 2018).

Risk factors for developing ICU delirium include age, multiple comorbidities (particularly respiratory disease), previous cognitive impairment, history of alcohol or drug abuse, sepsis, mechanical ventilation, major surgery, and pain. Use of medications also predispose patients to developing delirium. Narcotics, benzodiazepines, and steroids are amongst these medications. Additionally, medications that have anticholinergic properties or enhance dopamine effects can also increase risk for delirium. Levels of deep sedation and benzodiazepine infusions are associated with the highest risk for developing delirium (Alagiakrishnan, 2018; Hayhurst, Pandharipande, & Hughes, 2016).

Nurses should frequently assess patients in the ICU for delirium. There are multiple tools that are used for this assessment.
  •   Confusion Assessment Method for the ICU-7 (CAM-ICU-7),
  •   Nursing Delirium Screening Scale (Nu-DESC),
  •   Delirium Detection Score (DDS)

Of these tools the CAM-ICU-7 has shown the best validity in identifying ICU delirium (Indiana University, 2017).

Management includes reorienting patients, stimulating cognition, early mobility, and promoting sleep habits. Bundles may be used, which include weaning off ventilators and decreasing exposure to benzodiazepines. Fluid and nutrition management is important. Involving families in patient care and planning is also essential (Alagiakrishnan, 2018; Hayhurst, Pandharipande, & Hughes, 2016).

ICU delirium is an unfortunate occurrence of patient stays in the ICU. Understanding the impact of ICU delirium on patients including memory deficits, disorientation, and perceptual difficulties is essential for nurses caring for patients in the ICU. There are valid and reliable tools available to healthcare providers to identify patients who are experiencing ICU delirium.

Resource:
Confusion Assessment Method for the ICU (CAM-ICU) Flowsheet



References
Alagiakrishnan, K. (2018). Delirium. Retrieved from https://emedicine.medscape.com/article/288890-overview

Hayhurst, C, Pandharipande, P., & Hughes, C. (2016). Intensive care unit delirium: A review of diagnosis, prevention, and treatment. Anesthesiology, 125, 1229-1241.

Indiana University. (2017, March 14). Novel ICU delirium severity assessment tool developed. ScienceDaily. Retrieved www.sciencedaily.com/releases/2017/03/170314135445.htm  

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