“I Can Remember Sort of Vivid People…but to Me They Were Plasticine.” Delusions on the Intensive Care Unit: What Do Patients Think Is Going On?

Abstract

IntroductionPatients who develop intensive care unit (ICU) acquired delirium stay longer in the ICU, and hospital, and are at risk of long-term mental and physical health problems. Despite guidelines for patient assessment, risk limitation, and treatment in the ICU population, delirium and associated delusions remain a relatively common occurrence on the ICU. There is considerable information in the literature describing the incidence, suspected causes of, and discussion of the benefits and side-effects of the various treatments for delirium in the ICU. But peer-reviewed patient-focused research is almost non-existent. There is therefore a very limited understanding of the reality of delusions in the intensive care unit from the patient’s point of view.MethodA secondary analysis of the original interviews conducted by the University of Oxford Health Experiences Research Group was undertaken to explore themes relating specifically to sleep and delirium.ResultsPatients describe a liminal existence on the ICU. On the threshold of consciousness their reality is uncertain and their sense of self is exposed. Lack of autonomy in an unfamiliar environment prompts patients to develop explanations and understandings for themselves with no foothold in fact.ConclusionPatients on the ICU are perhaps more disoriented than they appear and early psychological intervention in the form of repeated orientation whilst in the ICU might improve the patient experience and defend against development of side-effects.

Critically ill patients' experiences of nursing care in the intensive care unit

“…It was also evident that current participants desired to be oriented not only to the interventions but also to what was happening in their surroundings. The importance of early patients' psychological intervention in the form of repeated orientation whilst in the ICU has been documented (Darbyshire et al ., ). Reported by Meuter et al .…”

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“…Respecto a los factores de riesgo, se destaca: Edad avanzada, tabaquismo (Yang et al, 2017), alcoholismo, que si bien la asociación aún no es clara, puede extenderse más allá de la abstinencia alcoholica, puede estar relacionado a deficiencias nutricionales o tener un marcador desconocido para el desarrollo del delirio (Wood et al, 2017), actividad física baja, bajo índice de masa corporal (<18,6 kg/m2), discapacidad auditiva, fibrilación auricular, antecedentes de accidente cerebrovascular, insuficiencia renal crónica, trastornos del sueño, depresión, antecedentes de delirio, medicación con benzodiazepinas, medicamentos neurolépticos, analgésicos opioides y múltiples medicamentos, polifarmacia, la cual se asocia con aumento de los eventos adversos, mayor interacción de los medicamentos y aumento de los costos (Garpestad y Devlin, 2017), la infección al torrente sanguíneo, inserción de catéteres y drenajes (Dittrich et al, 2016) y finalmente, el adormecimiento o somnolencia identificado con un RASS -1 (Boettger et al, 2017). Por otra parte, los factores precipitantes del delirio fueron la cirugía de emergencia, cirugía abierta, los catéteres permanentes múltiples, uso de analgésicos opioides y benzodiazepinas, la admisión a la unidad de cuidados intensivos (UCI), el ingreso a la sala de emergencias (Kim et al, 2016;Mori et al, 2016), puntaje SOFA (≥14) (Yang et al, 2017), y el delirio hiperactivo genera estancias más cortas y una menor mortalidad hospitalaria.…”

Don't go there – It's not a nice place: Older adults’ experiences of delirium

“…Participants in the study reported high levels of fear, using terms such as ‘terrifying’ and ‘scared’, emotions that are associated with aggressive behaviour (Brooke & Manneh ) Reduced sense of personal autonomy has also been associated with the aggressive behaviours sometimes observed in people with delirium (Darbyshire et al . ; Fagerberg & Jönhagen ). Understanding these emotions provides nurses with opportunities for intervention, including building trust, reorientation, and promoting a safe environment with predictable stimuli.…”