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Critically Ill Patients Can Become Confused in the Hospital: Here’s How to Cope

August 7th, 2018

It’s no wonder delirium is the most common complication among patients in the intensive care unit (ICU). ICU patients are critically ill. They are typically recovering from serious medical events like a stroke, brain injury or major surgery. Surrounded by equipment, they may not be able to see out a window and have no way to tell whether it is day or night. Their sleep is frequently interrupted for tests and monitoring. Machines beep and whir while staff come and go. In this environment, it is easy for patients to lose track of time, to become disoriented and confused.

Delirium is defined as rapidly developing and severe confusion accompanied by altered consciousness and an inability to focus. While alarming to observe, it is fairly common during hospitalization or recovery from surgery or stroke. An estimated 20% of those admitted to hospitals, up to 60% of those who have certain surgeries, and almost 80% of those treated in ICUs develop delirium.

A recent study sponsored by the National Institute on Aging sought to develop screening tools and evaluate the effects of delirium on both patients and caregivers. The study found that caregivers suffered higher degrees of distress than patients with delirium, both during hospitalization and afterwards.

“Delirium can be hard to diagnose,” said Kimon Bekelis, MD, Director, Stroke and Brain Aneurysm Center of Long Island and Co-Director, Neuro ICU at Good Samaritan Hospital Medical Center. “We cannot recognize it by looking at vital signs. As clinicians we tend to focus on what’s wrong with patients physiologically and may overlook delirium and its impact on patients and caregivers.”

Because the patients most at risk for developing delirium have often suffered a sudden medical emergency, it is almost impossible to prepare them for the possibility developing these symptoms. However, Dr.Bekelis noted that there are strategies to help families cope.

“We can prepare families and support them by explaining what delirium looks like,” he said, noting that family members who know in advance that their loved one may become disoriented while in the ICU are better equipped to deal with the situation.

And there’s good news: delirium is seldom a permanent condition.

“Delirium in the overwhelming majority of cases is temporary,” he explained. “Over the long term, folks are able to recover.”

At Good Sam, Dr. Bekelis noted that staff is trained to continually orient hospitalized patients to their surroundings, so for example nurses will remind their patients of the date, day of the week and time of day whenever they enter a room. Additionally, they try to maximize patients’ periods of uninterrupted sleep by reducing the frequency of blood draws or vital sign checks during the night, when possible.

Families can help by using similar strategies. Staying calm, understanding that delirium is common and reversible, and continually reorienting their loved one to the present by telling them the time of day and day of the week are recommended.

“Family members are a vital part of the care of the patient,” Dr. Bekelis said. “We encourage families to help with the process. It can be extremely impactful.”

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