Delirium in

the ICU
Emmy Kinner
 Prevalence 1

Community: 1-2%

Emergency Department: 10-30%

General Medical Unit: 14-24%

Post-Operative: 15-53%

Intensive Care Unit: 70-87%

Affects up to 83% of patients on mechanical ventilators.

 Types of Delirium 1

Hyperactive: agitation, restlessness, emotional liability, and positive

psychotic features

23%

Hypoactive: confusion, sedation, apathy, decreased responsiveness,

slowed motor function, withdrawn attitude, lethargy, and drowsiness

24-43.5%

Mixed: combination of the two forms with f luctuating features

52.5%
 Causes /Risk Factors 1

D- Drugs

E- Eyes /ears /other sensor y def icits

L- Low O2 states
I- Infection
R- Retention
I- Ictal State
U- Underhydration /Undernutrition

M- Metabolic causes
 Delirium Monitoring

Confusion Assessment Method- ICU (CAM-ICU) 2

Intensive Care Delirium Screening Checklist (ICDSC)

Intensive Care
Delirium Screening
Checklist 2
 How to Prevent Delirium

ABCDEF Model 3

A- assess, prevent, and manage pain

B- both spontaneous awakening and breathing trials

C- choice of analgesia and sedation

D- delirium assessment, prevention, and management

E- early mobility and exercise

F- family engagement and empowerment

 Managing Delirium 1

Pha r ma c olog ic a l

N on- Pha r ma c olog ic a l

• Tr ea t und er ly ing c a us e
• C or r ec t elec tr oly te dis tur ba nc es

• Remove of fend ing p ha r ma c olog ic a l a g ent

• M a inta in p r op er s leep / wa ke c yc les

• M a na g e p a in

• Enc oura g e fa mily v is its a nd fr eq uent r eor ienta tion – op en b lind s

• EAR LY M OB IL ITY
 Impact of ICU Delirium on Cardiac
Patients 4

Delirium in cardiac patients is linked to:

• Increased risk of cognitive decline

• Increased morbidity and mor tality

• Prolonged hospital stay

• Increased healthcare-associated costs

Studies have shown experience delirium is linked to worse quality of life

once out of the hospital
 My Experiences

Virtual Reality Goggles Exersides Refraint System

 References

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a nd IC D SC a s mea s ur es of d elir ium s ever ity in c r itic a lly ill a d ult p a tients .
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3 . M a r ra A, Ely EW, Pa nd ha r ip a nd e PP, Pa tel M B. The AB C D EF B undle in

C r itic a l C a r e. Cr i t Car e Cl i n. 2 0 1 7 ; 3 3 ( 2 ) : 2 2 5 - 2 4 3 .
d oi: 1 0 . 1 0 1 6 / j. c c c . 2 0 1 6 . 1 2 . 0 0 5

4 . Fa is a l H, Fa r ha t S, Gr ewa l N K, M a s ud F N . IC U D elir ium in C a r dia c

Pa tient. M e t ho d i s t De b akey Car d i ovas c J. 2 0 2 3 ; 1 9 ( 4 ) : 7 4 - 8 4 . Pub lis hed 2 0 2 3
Aug 1 . doi: 1 0 . 1 4 7 9 7 . mdc v j. 1 2 4 6