Lived Experience of the Intensive Care Unit for Patients Who Experienced Delirium

Whitehorne, Karen Mae Christine; Gaudine, Alice; Meadus, Robert J.; Solberg, Shirley

doi:10.4037/ajcc2015435

Cited by 18 publications

(22 citation statements)

References 17 publications

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“…Tse et al [21] proposed that age as well as certain pre-existing diseases and conditions are predictors of delirium after cardiac surgery. There are no recommended drugs or drug regimens to prevent delirium, so the focus should be on non-pharmaceutical interventions, including active communication, early detection of patients' psychological problems, family companionship, early activities, noise reduction, and good sleep [22].…”

Section: Discussionmentioning

confidence: 99%

Relationship between cerebral hemodynamics, tissue oxygen saturation, and delirium in patients with septic shock: a pilot observational trial

Feng

Huang

et al. 2020

Preprint

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Background Patients with septic shock are prone to have impaired cerebral autoregulation and to have an imbalance in cerebral oxygen metabolism. Transcranial doppler (TCD) and tissue oxygen saturation monitoring were performed to observe the changes in cerebral hemodynamic indices of the middle cerebral artery, and in cerebral and peripheral tissue oxygen saturation (StO 2 ) to identify risk factors for sepsis-associated delirium (SAD). Methods Patients with septic shock that were admitted to the Department of Critical Care Medicine of Xiangya Hospital of Central South University from May 2018 to March 2019 were prospectively enrolled, which were divided into an SAD group and a non-SAD group according to the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Both groups were compared with respect to patient characteristics, blood gas analysis indexes, organ function indicators, cerebral hemodynamic index, cerebrovascular automatic regulation function (transient hyperemia response rate, THRR index), the changes in regional cerebral oxygen saturation, and peripheral tissue oxygen saturation. Results The incidence of SAD was 39% (20/51). The overall 28-day mortality rate was 43% (22/51). Compared with the non-SAD group, patients in the SAD group required a longer mechanical ventilation time (5 days [95% confidence interval (CI) 2, 6] vs 1day [95% CI 1, 4], p=0.015) and ICU stay (9 days [95% CI 5, 20] vs 5 days [95% CI 3, 9], p=0.042) and has a higher 28-day mortality rate(65% vs 29%, p=0.011).Multivariate regression analysis showed that the THRR index (OR=5.770, 95% CI:1.222-27.255; p=0.027)and mean value of regional cerebral oxygen saturation (rSO 2 ) <55% (OR=3.864, 95% CI:1.026-14.550;p=0.046) were independent risk factors for SAD. Conclusions SAD has a high incidence in septic patients and is associated with poor prognosis. Our results provide a clinical basis for improving early detection and treatment of SAD.

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Section: Discussionmentioning

confidence: 99%

Relationship between cerebral hemodynamics, tissue oxygen saturation, and delirium in patients with septic shock: a pilot observational trial

Feng

Huang

et al. 2020

Preprint

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“…Not surprisingly, delirium is a distressing experience for patients, families, carers and healthcare staff (Grover 2014;Martins 2016). Qualitative research has reported on the experiential distress and resulting features of anxiety and depression that patients have after an in-patient episode of delirium (Whitehorne 2015). In particular, post-traumatic stress disorder (PTSD) is emerging as a recognised consequence of delirium and it has been suggested that it should be more routinely followed up, given its potential impact on patient recovery and quality of life (Teale 2013;Bolton 2019).…”

Section: Recoverymentioning

confidence: 99%

“…Recovery from delirium is an ill-defined concept in the literature, and although it is widely considered that delirium is often reversible, accumulating evidence suggests that it is often marked by incomplete resolution (Witlox 2010; Adamis 2014). Indeed, it has been found that, for each day a patient has delirium in the emergency department, a significantly worse long-term cognitive and functional outcome has been reported (Han 2017).…”

Section: Recoverymentioning

confidence: 99%

Delirium in the acute hospital setting: the role of psychiatry

Fitzgerald

Price

2020

BJPsych advances

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SUMMARY In this overview we discuss the role of psychiatry in managing delirium in acute hospital admissions. We briefly discuss the role psychiatry can offer in four main domains: (a) assessment; (b) management; (c) recovery; and (d) paradigm, education and research. In the assessment section we discuss accurately detecting delirium in the context of comorbid mixed neuropsychiatric syndromes, including depression and dementia, and the clinical importance of delirium subtyping. The management section briefly outlines pharmacological and non-pharmacological approaches to delirium and their evidence-based rationale. The recovery section focuses on the effect delirium can have on cognitive decline, mental health and long-term health, including functional outcome and need for institutional care after hospital discharge. Finally, we outline the role of psychiatry in delirium research and education. We hope that this article will encourage clinicians to reflect on their current practice and consider holistic and evidence-based care for this vulnerable population in the acute hospital setting.

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“…Some patients reported they heard music, sea waves, or had visions of dark or colorful tunnels; others felt like sailing on a ship. They also reported they felt they could be in several places such as a race track, a beauty salon, a building, a nightclub, describing in detail the characteristics of each place (15) .…”

Section: Real and Illusory Perceptions Of Patients In Induced Comamentioning

confidence: 99%

Real and illusory perceptions of patients in induced coma

et al. 2019

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Objective: To identify, in the scientific literature, real and illusory perceptions of adult patients in induced coma. Methods: This is an integrative review of 15 primary studies from the Medline, Web of Science, LILACS, CINAHL and SCOPUS databases. Results: The main memories reported after induced coma were thirst, cold, and pain. In some studies, patients reported they were unable to tell whether they were awake or dreaming, whether it was real or unreal. Satisfactory memories were reported by patients related to the care received and the use of bedside journals. Conclusion: Evidence showed a number of studies aiming to identify delirium, but without a focus on analyzing real or illusory perceptions of patients after induced coma. Thus, this integrative review identified scientific evidence of memories related to perceptions of sedated patients in the intensive care unit.

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Lived Experience of the Intensive Care Unit for Patients Who Experienced Delirium

Cited by 18 publications

References 17 publications

Relationship between cerebral hemodynamics, tissue oxygen saturation, and delirium in patients with septic shock: a pilot observational trial

Relationship between cerebral hemodynamics, tissue oxygen saturation, and delirium in patients with septic shock: a pilot observational trial

Delirium in the acute hospital setting: the role of psychiatry

Real and illusory perceptions of patients in induced coma

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