INTRODUCTION Advances in medical science and technology haveprompted the establishment of many highlyspecialized units (ICUs) providing intensive patientcare. ICU psychosis /Delirium in the intensive care unit isa serious problem that has recently attracted muchattention. As the number of intensive care units and thenumber of people in them grow, ICU psychosis isperforce increasing as a problem.
DEFINITION Eisendrath defined "ICU Syndrome" /"ICUpsychosis" as an acute organic brain syndromeinvolving impaired intellectual functioning andoccurring in patients treated within a critical careunit.
INCIDENCE It is commonly found in the critically ill with a reportedincidence of15-80% By some estimates, 80% of elderly intensive-carepatients develop the condition, which frequently leads tonursing home stays and a hastened death.
ETIOLOGY AND PRE DISPOSING FACTORS Sensory overload Sleep deprivation Immobilization Severe emotional stress Unfamiliar environment Dehydration Low Hemoglobin level Hypoxemia Pain Infection Drugs Prolonged stay in ICU and advancing age
CLINICAL MANIFESTATIONSSudden onset of impairment in cognition Disorganized thinking Difficulty in concentrating Problems with orientation in time and/or placeand/or person Altered affect, often with emotional liability Altered perception of external stimuli Impairment of memory Changes in sleep–wake cycle Hallucinations Agitation or change in activity levels
DIAGNOSTIC EVALUATION Confusion Assessment Method Mini mental status examination Explore other organic causes
MANAGEMENT The management strategy is to“wait and watch”.Non Drug Management Continuity of health care personal Clear concise communication Repeated verbal reminders of time, place andperson. Clock, calendar, TV, newspaper, radio readilyaccessible as a means of orientating in time
Simplify the environment, single room whenavailable, reduce noise levels, remove unnecessaryequipment Adjust lighting according to day and night cycle. Keep familiar objects Flexible visiting hours Allow maximum periods of uninterrupted sleep Encourage mobilisation and increase activity levels Relaxation techniques like music therapy andmassage may also help.
PHARMACOLOGICAL MANAGEMENT Antipsychotic agents such as haloperidol iscommonly used. Olanzapine and respiridone have been used asthey are less sedating and have fewer side effects Benzodiazepine would be beneficial, andlorazepam is the drug of choice.
OTHER THERAPEUTIC MEASURES Adequate pain management Avoid offending drugs Correct fluid and electrolytes Treat infection Administer oxygen Correct hypoglycemia Treat underlying cardiac problems
ASSIGNMENT Do a concealed observation of your ICU and find outthings and factors that can be avoided to preventICU syndrome also suggest some measures toprevent ICU syndrome. Formulate a scale to assess ICU syndrome
REFERENCES Lewis, Heitkemper, Dirksen O’Brien, Bucher. MedicalSurgical Nursing. Seventh edition. Nodia: Elsevierpublication; 2007.p no-1576-78,1736-37. Mark Borthwick. Richard Bourne. Mark Craig. AnnetteEgan. Prevention and Treatment of Delirium in CriticallyIll Patients. United Kingdom Clinical PharmacyAssociation. June. 2006. Granberg. Malmros. Bergbom. Lundberg. Intensive CareUnit Syndrome/Delirium Is Associated With Anemia,Drug Therapy And Duration Of Ventilation Treatment.Acta Anaesthesiol Scand 2002; 46: 726–731 Sandeep Jauhar .When A Stay in Intensive CareUnhinges the Mind. The New York Times. December 8,1998. Richard C. Monks. Intensive Care Unit Psychosis.Canadian Family Physician. Vol. 30: February 1984, PNo- 383-389