Delirium is one of the unresolved challenges to medicine.
Delirium is a serious acute medical condition; effectively a medical emergency. It can result in serious adverse outcomes for many patients – death and dementia. In any other condition it would have clinicians searching for information with the same commitment given to cancer or HIV.
Delirium? It’s a familiar term in and out of hospital describing a distressing experience of disorientation and agitation. We think we can all recognise the delirious patient, unable to reason, often a danger to themselves and staff. But in fact most delirium goes undiagnosed as it is a quiet confusion, a brain failing by shut down rather than firing up. Look through this website, access the links, inform yourselves and tell friends and colleagues.
Delirium in ICU?
Delirium is the commonest neuropsychiatric condition in hospital, 15% to 25% on general medical wards, up to 60% on surgical wards – critical care 80% in the sickest ventilated patient. These are the hard facts. There are no 2 ways about it. Yes there is (and always has been) a currently grossly under diagnosed condition in your critical care unit that will influence whether the patient lives or dies regardless of expensive drugs, vasopressin or low-volume ventilation. It can be diagnosed in 2 minutes in an easy to apply, non-invasive test with no equipment needed. Throw down the gauntlet, fight delirium.
This UK website is the first in the country about ICU delirium incidence and outcomes. It teaches you how to detect it in sedated and ventilated patients and it’ll help you to teach others and implement the monitoring in your unit. It informs about what’s known about the management and treatment of delirium with news and developments. Finally there are links and the opportunity to ask questions or express your opinions.
Thanks to the Alzheimer’s Society and Mr J.W. Dalling for having the foresight and imagination to resource this project.
Hello, I had written you earlier, not sure if you didn’t reply or the email was entered wrong. I would like to get my hands on the little cheat booklets you have for the ICU CAM. We are introducing this into our unit and find them very helpful, our ICU is in Ottawa, Canada.
Thanks so much for your time, love the website.
Cheers,
Mandy
I would like to thank you for this site..
I myself worked in the field of ICU delirium, and I have made a study with italian friends (multicenteric study in italy and Egypt, my home country)..
it is under publishing..
looking for possible future contact and experience exchange
thank you very much
Do you individuals have a facebook fan page?
No facebook fan page yet but look out for the European Delirium Association facebook page which is currently being developed.
Hi, this is the new Facebook page for the European Delirium Association. Look out for announcements in the lead up to the 6th Scientific Congress in Umea in November.
http://www.facebook.com/EDA.delirium
In October 21, 2011 I was merciless and for not reason gunshot in my face. When I got to the hospital I ready 85 % of my blood was lost the bullet broke my Carotid artery. I died a minute after I got to hospital. Successful resuscitation was performed and I returned to life. However, while in ICU I had Delirium. It was terrible experience. I have wrote a least 30 episodes of this delirium. It was a mixture of paranoid and schizophrenic state. I believe that at least I was not able to sleep because of these phantasmal visions and many machines noises. it suffering was for ten days. As soon as I was transferred to trauma I had my last horrible experience, but i was in complete panic. In all I believe that I was in complete delirium for two weeks. However, a month and half I was able to return to the University and I passed my three first classes with A’s and B’s. ICU delirium Is deep terror in the most extreme way. I never before have feel the most deep fear as when I had ICU delirium.
My dad was diagnosed with lymphoma and was admitted with a huge blood clot in his arm. The pain was terrible. He was given morphine which initially resolved the acute pain. However within hours he was starring at the ceiling counting the dots. He became quiet and withdrawn and it was hard for him to break his stare to look at us. I told the nurse that I believed my Dad was sffering from dilirium and she said she would call the GP. She obviously did not know the symptoms of dilirium. My Dad, an anglican priest in the community where he was in hospital (i.e. well known) had terrible dreams about robbers attacking him in his hospital bed, and he climbed out of bed in the night. After that he was physically restrained, had his glasses taken away, and he was given just .5 mg haldol IV twice a day for nausea! The dilirium was never addressed by the GP because when my dad spoke to the GP, he was polite, and quiet. He wouldn’t share his fears with him. The GP paid no attention to our complaints. My Dad stayed in that state for 5 weeks. He was confused, irritable and ended up in diapers because no one wanted to go near him. When a pain doctor came to visit my Dad (he happened to play golf with my Dad and saw he was in hospital), he immediately recognized the dilirium and just changed the narcotic to a fentanyl patch. My Dad became reasonable again. Sadly, my Dad died 10 days later of an aspiration pneumonia following chemotherapy. My mother grieves for him, and feels such a sense of loss for those 5 weeks when my Dad was so confused and afraid. I am an ICU nurse with many years of treating dilirium. I was so frustrated by the lack of knowledge the GP seemed to have about dilirium, even though he was the most responsible physician, I was powerless to convince him that he was witnessing dilirium related to narcotics. I will always regret not making a big enough stink to get help for my Dad. Maybe this testimonial will help some readers understand the impact of dilirium on patients and families. It was so unnecessary that my Dad had such an end of life experience when the treatment seemed to be so simple.
Thank you for writing this and I will circulate this account to as many clinical colleagues as I can, starting with the European Delirium Association. Clinicians need to be a recognise quiet delirium - the still apparently compliant patient as no doubt your father was - for what it is.
About 2 years ago I have a heart attack in my sleep and my dad found me and went ahead with CPR. This ended up with all sorts of complications but eventually I was sabalised by paramedics. One of the complcations was a life threatening chest infection which required me to be sedated for at least 4 weeks. While I was deep in sedation I was having terrorifing hellusanation in completely different places than I actually was and by terrorfing I mean worst fears come true even if its not possible e.g. flying around streets. Eventually when the sedation started to wore off the delerium turned into paranoia e.g. being killed by doctors or nurses that was careing for me this was fuelled by hearing and seeing things that wasn’t actually happening. I had no after care at all and nobody even seemed to care this delerium needs adressing more after treatment this is the first website iv ever seen for this problem. Thankyou for everybody else sharing problems.
Thanks Rob. Some patients will just experience the paranoia which I believe is delirium as well. If you can see it for what it was - confusion caused by illness and medication - that is the important step. Follow-up in intensive care is a relatively new development and it is only now that ICU clinicians are realising the impact of delirium.
It is inevitable many ICU patients will develop delirium regardless, but understanding it and talking to patients about it is a crucial part of intensive care medicine. Good luck!
Hi Valerie, I am a nursing student currently looking into assessment tools and non-pharmacalogical treatment of delirium. The ICU ward I am currently placed on has recently implemented CAM-ICU but the nurses do not seem to be on board with the idea - do you think that a more efficient, streamline tool to test for delirium may be more easily implemented? The evidence suggests that the sensitivity of such tools are decreased but perhaps this would be balanced out with more nurses using it? Also do you know of any current evidence, such as performed by Inouye in 1999 that looks at non-pharm management? I feel that the nurses may not be taking ownership of the test as there is a lack of evidence based guidelines and evidence to reduce it.
Thanks
The bottom line is that implementing delirium screening and management is challenging. The key is to have a core group of nurses who recognise its importance and a consultant in support. Once the benefits are seen - and that may take 6 months or so but they will come - then bedside nurses will assess routinely. The screening tool is an aid (the CAM-ICU is as streamlined as they come), try getting intubated patients to recite the months of the year backwards, ask patients directly about hallucinations. Get them interested in the patients cognition.The point is that we are monitoring the brain with a view to improving outcomes. Try and get the nurses to think about why as much as the how!
If they do not know the patient has delirium or not then the lack of evidence is irrelevant. As Professor Ely wrote: Delirium is bad, whats the confusion?
Good luck and never, never give up!
HI,
Iam looking forward to do a audit on delirium in my ICU in Galle ,Sri Lanka.