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.