HealthCare

What is the most effective way to reduce ICU delirium?

Powerful Tools to Reduce ICU Delirium: Medications, Family, Mobility, Sleep

There are four powerful tools to prevent and treat ICU delirium. One is to avoid medications that cause delirium. Medications such as propofol, midazolam, lorazepam that come with high risks of ICU delirium must be avoided unless there's a very specific reason and indication for their use. Two is family involvement. Family presence and engagement at the bedside is a powerful tool to help prevent and treat ICU delirium. Three is mobility. Sitting, standing, walking, sitting upright during the day helps prevent and treat ICU delirium. And four is sleep. Real restorative sleep, grouping our cares, minimizing disruptions at night, all help treat ICU delirium. And keep in mind that when patients are sedated in medically induced comas, that sedation is preventing sleep which is one of the ways in which ICU delirium occurs. So avoiding those medications, family, mobility, and sleep are all potent ways to reduce ICU delirium.

The four powerful tools to prevent and treat ICU delirium are avoiding medications that cause delirium, family involvement, mobility, and sleep.

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To effectively reduce ICU delirium, there are four powerful tools to consider. Firstly, it is important to avoid medications known to cause delirium, such as propofol, midazolam, and lorazepam, unless absolutely necessary. Secondly, involving and engaging the patient's family at the bedside can be highly effective in preventing and treating ICU delirium. Thirdly, promoting mobility by encouraging patients to sit, stand, walk, and maintain an upright position during the day can help prevent and treat delirium. Lastly, prioritizing restorative sleep by minimizing disruptions at night and grouping cares together can significantly contribute to reducing ICU delirium. It's worth noting that when patients are sedated in medically induced comas, the sedation itself prevents proper sleep and can contribute to the occurrence of ICU delirium. By avoiding certain medications, involving family members, promoting mobility, and ensuring quality sleep, we can greatly reduce the risk of ICU delirium.

What are the warning signs of ICU delirium?

Identifying ICU Delirium: Key Warning Signs to Watch

Some of the warning signs of ICU delirium include confusion, inattention, lethargy, or agitation, nonsensical statements or behaviors, audio or visual hallucinations. All of these are signs that there's disruption occurring in the brain, and that your loved one may be developing the life-threatening and altering complication of ICU delirium. The sooner we identify those early warning signs of ICU delirium, the quicker we can intervene with those four tools of avoiding medications that cause delirium, family involvement, more mobility, more sleep. Because the shorter the duration and less severe the ICU delirium is, the better chance your loved one has to survive and thrive.

Warning signs of ICU delirium include confusion, inattention, lethargy, agitation, nonsensical statements/behaviors, audio/visual hallucinations. Quick intervention with avoiding medications that cause delirium, more family involvement, more mobility, and more sleep can help reduce the duration and severity of delirium.

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Warning signs of ICU delirium include confusion, inattention, lethargy, agitation, nonsensical statements or behaviors, and audio or visual hallucinations. These signs indicate disruption in the brain and suggest that a loved one may be developing the life-threatening complication of ICU delirium. Identifying these warning signs early allows for prompt intervention through strategies like avoiding medications that cause delirium, involving family members, promoting mobility, and ensuring adequate sleep. The shorter the duration and less severe the ICU delirium, the higher the chances of survival and recovery for your loved one.

In your opinion, should the ABCDEF bundle be standardized in all ICUs around the world, and why?

Standardizing the ABCDEF Bundle: A Lifesaving ICU Necessity

Yes, absolutely. The ABCDF bundle should be standardized in all ICUs around the world. This should be just as basic as hand hygiene. If we know that the ADEF bundle increases survival by 68%, then we have no business caring for patients in any other way than the best way to give them a chance to survive and thrive.

Yes, the ABCDF bundle should be standardized in all ICUs around the world.

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Yes, the ABCDEF bundle should definitely be standardized in all ICUs worldwide. Its implementation should be considered as fundamental as practicing hand hygiene. The fact that the ADEF bundle has been shown to increase survival rates by 68% makes it clear that there is no justification for not providing patients with the best possible care to give them the highest chance of survival and recovery.

How can you help a patient that is agitated while they are intubated on a ventilator in the ICU?

Managing Agitation in Ventilated ICU Patients: Key Strategies

This is a really important question because agitation can be a very common occurrence, especially in ICUs that automatically start sedation on patients and then try to take it off later. Because when we start sedation, we likely cause, exacerbate, or prolong ICU delirium. And when that happens, when we take sedation off, we unmask that delirium, which can cause patients to come out very agitated. They can pull against the restraints, they can be trying to pull other endotracheal tube, trying to bite the tube, trying to hit people. It can be an emergency in a really difficult situation. So as we go to take sedation off, we need to slowly wean it down. As patients start to come out, open their eyes, respond to their environment, we need to have family members right there talking to their loved one, making eye contact, touching them, saying you're okay, you're safe, I'm here. Reorienting them, assess their needs, make sure that they are having their pain treated. And then one of the most potent tools to treat restlessness, agitation, discomfort is to sit patients up at the side of the bed. So if they are thrashing and dangerous with sedation off, maybe we need to have it on at a much lower dose, but let them be awake enough to sit at the side of the bed, maybe then try to stand, maybe even walk. And it is powerful to see how much patients calm down, connect with their environment, start to make eye contact, follow commands, answer questions, things like that, when they are allowed to be up and mobile. So that is one of the most powerful ways to prevent agitation, but also to treat it and as well as treat delirium in the ICU. We need to be assessing for the cause of the agitation and treating the cause, rather than resuming that deep sedation that is likely one of the main culprits of the agitation that we're seeing.

Agitation in ICU patients can be treated by slowly weaning sedation and having family members reorient them. One of the most effective treatments is sitting the patient up at the side of the bed and allowing them to be up and mobile. Assessing for and treating the cause of agitation is key, rather than reverting to deep sedation.

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Helping an agitated patient who is intubated on a ventilator in the ICU is a crucial task. Agitation is common, especially when sedation is initially administered and then reduced later on. Starting sedation can worsen or prolong ICU delirium, which becomes unmasked when sedation is decreased and can lead to extreme agitation. To address this, we need to slowly wean off sedation and have family members present to provide reassurance and comfort. Reorienting the patient, assessing their needs, and ensuring pain management are essential steps. One potent method to alleviate restlessness, agitation, and discomfort is to sit patients up at the side of the bed. If they are dangerous without sedation, a lower dose may be necessary while allowing them to be awake enough to sit up, stand, or even walk. This approach helps patients calm down, engage with their environment, make eye contact, follow commands, and respond to questions. It's vital to identify the underlying cause of agitation and address it rather than resorting to deep sedation, which often contributes to the agitation observed in these cases.

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Kali Dayton,DNP,AGACNP answers your HealthCare questions. See all the advice Kali Dayton,DNP,AGACNP has and get answers to your own HealthCare questions.

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Kali is a nurse practitioner that specializes in sedation and mobility practices in the ICU. 

She is the host of 2 podcasts: 
“Walking Home From the ICU” is dedicated to helping ICU clinicians understand patient perspective and current research around medically-induced comas. 

“Walking You Through the ICU” provides information, perspective and tools to help loved ones of ICU patients advocate for practices for the best chance to survive and thrive. 

Kali trains ICU teams to become “Awake and Walking ICUs” through current research and humane treatments. She supports patient advocates to help ICU teams the ABCDEF Bundle in their loved one’s care in the ICU.