Comments on: Diagnosing Delirium

By: Valerie Page

Valerie Page — Tue, 20 Dec 2011 08:09:21 +0000

The impact of delirium on relatives and friends cannot be underestimated not the least of which is concern that it will not recover. The facts are a percentage of patients are left with persistent delirium but that is only considered after there are no signs of recovery despite treating the cause(s) at 3 months. I understand your concern and he may be left with some problems concentrating but as/if he recovers from the complications and gets stronger I would expect a very good chance his delirium will clear over time.

By: Lisa

Lisa — Tue, 13 Dec 2011 20:38:40 +0000

My father has been in ICU in 3 different hospitals for just under a month following an op for aortic dissection, subsequent complications e.g. pneumonia, and now icu delirium. I am beginning to lose hope for a good outcome despite reassurances by medical staff.

By: Valerie Page

Valerie Page — Fri, 25 Nov 2011 15:31:47 +0000

Feature 1 is altered mental status so essentially a patient who is not themselves or has behaved oddly in the previous 12-24 hours, asking inappropriate questions would qualify. There is a screening tool which asks a relative “is this what XX is usually like?”. That would answer feature 1. RASS can be used but if 0 would not mean feature 1 is negative.
The CAM-ICU is not as sensitive at diagnosing delirium in non-intubated patients - patients not on ventilators who are able to talk. (It is very specific so a CAM-ICU +ve patient will have delirium.) Alternatives include the ICDSC - see under screen for delirium above - or the 4AT has impressed me, if you are looking for a quick screening tool http://www.the4AT.com/home.
There are a number of other screening tools used in general medical settings which usually would take 10-15 minutes or are observations recorded over a shift (which is essentially how the ICDSC works). Frankly even in expert hands the diagnosis of hypoactive delirium can be challenging.

By: Karen Cotton

Karen Cotton — Wed, 16 Nov 2011 10:33:18 +0000

I wondered if anyone else has a concern over the RASS scoring part of the testing. I have a bit of a theory that it isn’t recorded frequently enough to satisfy feature 1 and also sometimes a patient who may be drowsy (-1) is scored as 0 (Alert & calm) and therefore the patient is thought to be negative without proceeding. My second observation is: do you think some patients pass the test who are still delirious as I tested one man recently who was negative but before I had left the bedspace asked how he was getting home. Thank you

By: Valerie Page

Valerie Page — Fri, 11 Nov 2011 14:06:42 +0000

It is only in the last few years that the significance and impact of delirium has been appreciated in ICU. Frankly there are still a few influential sceptics. I have, in fact, produced an information sheet for the relatives and carers of our ICU patients which informs them about delirium. It does sound like your father would inevitably get delirium given his septicaemia from perforated bowel. I hope he makes a good recovery.

By: beryl swift

beryl swift — Sat, 29 Oct 2011 19:21:56 +0000

my dad is in an ICU unit after undergoing a bowel resection after an accident where his bowel was perforated and he got septicemia post op he was mechanicaly ventilated for five days reduced gradually over the next two days.
he was previously an 84 yr old who was lucid computer literate,drove and managed the day to day running of his house and elderly wife,
From a relatives point of view and the little I know of ICU Delirium I am shocked and suprised that we were not pre-warned of this condition, and advised how we might aid my Dads recovery so reducing further implications from this condiion.

By: fadzai mashingaidze

fadzai mashingaidze — Mon, 18 Apr 2011 15:42:43 +0000

very interesting topic indeed.I am a critical care nurse undertaking my ICU course with a huge interest in ICU delirium. I am currently doing my assignment on subject topic, got to say this condition is under diagnosed and nurses’ attitude towards cognitive impairment in the ICU ought to change.

By: Valerie Page

Valerie Page — Tue, 09 Nov 2010 12:30:30 +0000

Dear Peena.
A valid way of looking for inattention is to use a series of pictures. You show the patient 5 simple drawings and then show those 5 mixed up with another 5 and ask them to indicate which ones they were shown first (eyebrow communication?). The instructions and pictures are free to download from http://www.icudelirium.org in the CAM-ICU assessment tools. On that website there are also a list of frequently asked questions which are very useful as well.
Thanks Valerie

By: Peena Kavarana

Peena Kavarana — Mon, 08 Nov 2010 14:20:30 +0000

I find this all very interesting, and agree that recognising ITU delirium is important. However, how do we recognise this in a patient who cannot squeeze hands, or who cannot raise hands, e.g., high leison spinal patients, those with ITU neuropathy, or who are just too weak to move their arms? I have nursed patients with Guillain-Barre Syndrome and encephalitis, and therefore have seen patients who can perhaps only just move their eyebrows a tad. Is it possible to screen for ICU delirium in such patients? Or do we just have to wait and let the patient suffer? I welcome your thoughts!

By: Valerie Page

Valerie Page — Fri, 22 Oct 2010 14:11:18 +0000

Dear Frances
Thank you for writing in. Patients and relatives experiences are very powerful in getting the message across to clinicians about how important delirium is and why we have to do something about it now. I wonder if you are aware of the website ICU steps http://www.icusteps.com/ for ex-ICU patients. One of the trustees recently gave an interview for Radio 4 on her experiences. I hope you have started to see a change for the better in ICU practice of managing delirium.