ICU delirium is America’s most serious and pervasive public health issue that no one seems to have heard of. It needs to be discussed more

ICU delirium is America’s most serious and pervasive public health issue that no one seems to have heard of. It needs to be discussed more

Every day, day in day out, 365 days per year, upwards of 60,000 Americans are admitted to the Intensive Care Unit of a hospital because they have a critical illness that, left untreated and unattended to, could quickly kill them or leave them gravely disabled. And it is a very sad fact that some people will die in the ICU regardless of the amount and quality of care they receive. Most people realize this.

What many people do NOT realize is that once hospitalized in the ICU, a patient’s susceptibility to death in the ICU expands well beyond the dangers posed by the actual illness which necessitated their ICU stay. One of these dangers is delirium and what makes it especially dangerous is that people who should know better – physicians, surgeons, nurses and other hospital providers – fail to advise patients or their loved ones about the realities of ICU delirium – that it’s presence in a critically-ill patient can, independent of the main illness itself, increase the patient’s odds of dying in the hospital by 100%, 200% even 300% and that upwards of half the patients who develop delirium during their stay will likely develop a form of long term cognitive impairment  on a par with the dementia seen in early Alzheimer’s Disease patients.

Worse yet, for decades physicians have been informing concerned family members quite wrongly that ICU delirium (often still referred to inaccurately and archaically as ICU ‘psychosis'[sic])  is a harmless and transient condition, a mere ‘artifact’ of their critical illness that simply goes away on its own.

It is when such misinformation is conveyed either knowingly or self-servingly that great harm to the patient can result because the prevailing belief by leading researchers in this area is that the severity of ICU delirium can be diminished and possibly even eliminated through the simple but time-consuming expedient of ‘titrating’  or adjusting psychoactive medications  given to ICU delirium patients such as tranquilizers and pain medication to the lowest dose consistent with safe care of the patient. The loved ones of ICU patients can continue to urge staff to abide by one of several protocols developed for just this purpose but they can only do so if they are aware that such changes can be made and that they can make a huge difference in the future health and well being of their patient if they do so.

The indispensable role of family members to the ICU patient

One of the most important roles you can play as a family member of someone in the ICU is as a medical historian, specifically in terms of assuring that attending physicians are made fully aware of the patient’s overall pre-ICU cognitive state. Without this information, neither RNs nor MDs nor therapists can properly assess the current condition of your loved one.

 No matter how assertive they are in everyday life, the conditions which brings a person to the ICU will utterly disable them from properly advocating for themselves while they are patients there. It is absolutely critical -often literally a matter of life or death – that loved ones be near their patient 24/7 in the ICU.and that they be willing to be aggressive to a degree which most of us would not think of being outside the hospital.

A change in mentation is inevitably more quickly apparent to a family member than to even the most attentive clinician. Such changes can often be stopped in their tracks by a simple medication adjustment. A delayed or absent adjustment can lead to a very rapid decline and often a quick death.

The ICU Patient is, was or someday will be you or someone you love.

[Hospitals must] make a culture shift in how they handle their sickest patients in the ICU.”  Wes Ely, M.D. MPH, Professor of medicine and director of the ICU Delirium and Cognitive Impairment Study Group at the Vanderbilt University School of Medicine

This  first post marks the beginning of what hopefully over time will become both a tool for American ICU patients and their families as well as an occasionally thoughtful discussion of the roadblocks which now stand in the way of better treatment for the ICU patient, whether the patient is an inpatient still in the ICU,  an inpatient in a “step-down” hospital unit or after discharge from the hospital as an outpatient.

It is directed principally towards an American readership because it is in the United States that I seek to help effectuate change in ICU practices, particularly with regard to the treatment of ICU delirium. Regrettably and frankly shamefully, the United States is far behind the United Kingdom in this area.

The purposes of this blog are two-fold.  First, it is to help ICU patients and their families understand that the perils of hospitalization for a critical illness extend far beyond the confines of the original illness itself. Second, it is to promote positive patient-centered changes in ICU “culture”, in particular in recognizing the hazards of ICU delirium as well as the significant role which family members can play in helping their loved ones survive their ICU and hospital stay while minimizing the brain damage which can lead to disabling long term cognitive impairment.