Intensive care unit delirium - does prolonged intensive care unit stay increase morbidity
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20201061Keywords:
ICU delirium, Femur fracture, Post-operative care, Delirium management, ICU care, Old age careAbstract
Background: The term intensive care unit (ICU) delirium or ICU psychosis denotes the transient period of psychosis exhibited by the geriatric patients placed in long term ICU care. This condition can be mistaken for organic neurological deterioration and can result in improper treatment, delayed rehabilitation and longer ICU stay. The objective of the study was to analyse the outcome of early ward rehabilitation in post-surgical patients with ICU psychosis.
Methods: This is a retrospective case control study of 45 geriatric patients (above 60 years of age) who developed delirium or psychosis after long term ICU stay (>4 days) following a major trauma and orthopaedic procedure. Of the 45 patients, 28 patients (group A) were shifted out of ICU after haemodynamic stability despite continued delirious episodes. The remaining 17 patients (group B) were those who were retained in the ICU for complete neurological recovery.
Results: Significant positive difference was noted in patients who were shifted out of ICU early (group A) compared to group B. Group A patients had faster recovery, lesser delirious episodes (2.3±0.9 compared to 13.4±2.7) and fewer days of hospital stay (4.9±1.2 compared to 12.4±2.6) when compared to group B. None of the patients had any episodes of psychosis after discharge from the hospital when followed up for duration of 6 months.
Conclusions: Post-operative geriatric patients diagnosed with ICU psychosis fare better with early out of ICU mobilisation. It is not essential to wait for full neurological recovery to shift these patients out of ICU though close ward monitoring may be essential in some cases.
References
Monks RC. Intensive care unit psychosis. Canadian Family Physician. 1984;30:383.
Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nature Rev Neuro. 2009;5(4):210.
Aldemir M, Ozen S, Kara IH, Sir A, Baç B. Predisposing factors for delirium in the surgical intensive care unit. Critical care. 2001;5(5):265.
Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Critical care. 2008;12(3):3.
Pandharipande P, Cotton BA, Shintani A, Thompson J, Pun BT, Morris JA, et al. Prevalence and risk factors for development of delirium in surgical and trauma ICU patients. The J of trauma. 2008;65(1):34.
Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Jama. 2004;291(14):1753-62.
Inouye S, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Jama. 1996;275(11):852-7.
Lundstrom M, Edlund A, Karlsson S, Brannstrom B, Bucht G, Gustafson Y. A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J of the Amer Geriatr Soci. 2005;53(4):622-8.
Khan BA, Perkins AJ, Gao S. The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU. Crit Care Med. 2017;45(5):851-7.
