Patients and Families Overview
What is delirium? The word “delirium” is used to describe a severe state of confusion. People with delirium:
- Cannot think clearly
- Have trouble paying attention
- Have a hard time understanding what is going on around them
- May see or hear things that are not there. These things seem very real to them.
Delirium is common. About 2 out of 3 patients in ICUs get delirium. Seven out of 10 patients get delirium while they are on a breathing machine or soon after. Experts think delirium is caused by a change in the way the brain is working. This can be caused by:
- Less oxygen to the brain
- The brain’s inability to use oxygen
- Chemical changes in the brain
- Certain medicines
- Severe pain
- Medical illnesses
- Alcohol, sedatives, or pain killers
- Withdrawal from alcohol, nicotine
What Might Survivors Experience
Cognitive impairment refers to difficulties in thinking which are sometimes mild and sometimes severe and can include trouble with memory and attention as well as other problems. A recent study of over 800 critically ill patients showed that greater than 50% of patients had cognitive impairment one year following critical illness. Delirium was the number one predictive factor for cognitive impairment. 1/3 of patients had cognitive impairment that was similar to Alzheimer's Disease and 1/3 of patients had cognitive impairment that was similar to someone following a traumatic brain injury.
PTSD is a mental health condition triggered by exposure to a traumatic and extremely disturbing event.
Depression is a mental health condition characterized by symptoms such as feelings of sadness and disinterest as well as physical symptoms such as lethargy and fatigue.
People most likely to get delirium are those who:
- Have dementia
- Are advanced in age
- Have surgery, especially hip or heart
- Have depression
- Take certain high-risk medicines
- Have poor eyesight or hearing
- Have an infection or sepsis
- Have heart failure
Signs of delirium you may see in your family member are:
- Appearing agitated or even quiet
- Using inappropriate words
- Inability to pay attention or follow directions
- Unsure about where they are
- Unsure about the time of day
- Seeing things that are not there
- Acting different from usual
- Changes in sleeping habits
- Emotional changes
- Abnormal movements, like tremors or picking at clothes
- Memory problems
Delirium is different than dementia.
- Delirium comes on quickly, in hours or days. Signs of delirium can change from one day to the next.
- Delirium can make memory and thinking problems worse.
- Delirium usually clears up after a few days or even a week.
- Dementia is usually a permanent condition.
- Dementia is a disturbance of thinking. It comes on over months or even years.
- Patients with dementia are more likely to develop delirium.
People often ask if delirium causes thinking problems after a patient leaves the hospital. Research shows that patients who develop delirium might have “dementia-like” thinking problems that can last for months. At this time we cannot predict who might develop “dementia-like” thinking problems.
How family/friends can help ICU patients:
- Speak softly and use simple words or phrases
- Remind the patient of the day and date.
- Talk about family and friends.
- Bring glasses, hearing aids.
- Decorate the room with calendars, posters, or family pictures.These familiar items might be reminders of home.
- Provide the patient with favorite music or TV shows.
- If your loved one has delirium, you might be asked to sit and help calm them.
Hospitals Take On Post-ICU Syndrome, Helping Patients Recover
The Wall Street Journal
Millie Camp, 63, was admitted to an ICU at Vanderbilt in March with acute respiratory distress syndrome with suspected sepsis. After more than two weeks immobilized on a ventilator, she could barely sit up in bed or push a button to call a nurse. The ICU Recovery program helped design a rehabilitation program and referred her to the university's Voice Center, where she could overcome aftereffects from the breathing machine and resume singing in a barbershop chorus. She is vigilant about exercise, at first taking classes while toting an oxygen tank. "You have to see each step as an accomplishment and a blessing, and not be burdened about what you can't do," Ms. Camp says.