1. DELIRIUM A significant ICU problem!
What is it? An acute change in consciousness that is accompanied by inattention and either a change in cognition or perceptual disturbance. May be hypoactive or hyperactive in nature.
Who’s at Highest Risk? Patients with pre-existing dementia; history of hypertension; alcoholism; and increased severity of illness.
Causes of Delirium:
T – Toxic situations (CHF, shock, dehydration,
deliriogenic meds, new organ failure)
H – Hypoxemia
I – Infection/sepsis; immobilization
N – Nonpharmacologic interventions being neglected (hearing aids, glasses, uninterrupted sleep, music, noise control, ambulation)
K – K+ or electrolyte problems
What can we do to Help?
A – Awakening
B – Breathing trials (spontaneous breathing trials daily)
C – Choice of Sedation (decrease BZP use; use alternate sedation)
D – Delirium Detection (screening qshift
using ICDSC; review of medications)
E – Early Progressive Mobility and Exercise