icu psychosis
TRANSCRIPT
ICU SYNDROME/ICU PSYCHOSIS
Presented by
Basil Kuriakose
INTRODUCTION
Advances in medical science and technology have prompted the establishment of many highly specialized units (ICUs) providing intensive patient care.
ICU psychosis /Delirium in the intensive care unit is a serious problem that has recently attracted much attention.
As the number of intensive care units and the number of people in them grow, ICU psychosis is perforce increasing as a problem.
DEFINITION
Eisendrath defined "ICU Syndrome" /"ICU psychosis" as an acute organic brain syndrome involving impaired intellectual functioning and occurring in patients treated within a critical care unit.
INCIDENCE It is commonly found in the critically ill with a
reported incidence of15-80% By some estimates, 80% of elderly intensive-care
patients develop the condition, which frequently leads to nursing home stays and a hastened death.
ETIOLOGY AND PRE DISPOSING FACTORS
Sensory overload Sleep deprivation Immobilization Severe emotional stress Unfamiliar environment Dehydration Low Hemoglobin level Hypoxemia Pain Infection Drugs Prolonged stay in ICU and advancing age
CLINICAL MANIFESTATIONS
Sudden onset of impairment in cognition Disorganized thinking Difficulty in concentrating Problems with orientation in time and/or
place and/or person Altered affect, often with emotional liability Altered perception of external stimuli Impairment of memory Changes in sleep–wake cycle Hallucinations Agitation or change in activity levels
DIAGNOSTIC EVALUATION
Confusion Assessment Method Mini mental status examination Explore other organic causes
MANAGEMENT
The management strategy is to “wait and watch”.Non Drug Management Continuity of health care personal Clear concise communication Repeated verbal reminders of time, place
and person. Clock, calendar, TV, newspaper, radio readily
accessible as a means of orientating in time
Simplify the environment, single room when available, reduce noise levels, remove unnecessary equipment
Adjust lighting according to day and night cycle.
Keep familiar objects Flexible visiting hours Allow maximum periods of uninterrupted
sleep Encourage mobilisation and increase activity
levels Relaxation techniques like music therapy and
massage may also help.
PHARMACOLOGICAL MANAGEMENT
Antipsychotic agents such as haloperidol is commonly used.
Olanzapine and respiridone have been used as they are less sedating and have fewer side effects
Benzodiazepine would be beneficial, and lorazepam is the drug of choice.
OTHER THERAPEUTIC MEASURES
Adequate pain management Avoid offending drugs Correct fluid and electrolytes Treat infection Administer oxygen Correct hypoglycemia Treat underlying cardiac problems
ASSIGNMENT
Do a concealed observation of your ICU and find out things and factors that can be avoided to prevent ICU syndrome also suggest some measures to prevent ICU syndrome.
Formulate a scale to assess ICU syndrome
REFERENCES
Lewis, Heitkemper, Dirksen O’Brien, Bucher. Medical Surgical Nursing. Seventh edition. Nodia: Elsevier publication; 2007.p no-1576-78,1736-37.
Mark Borthwick. Richard Bourne. Mark Craig. Annette Egan. Prevention and Treatment of Delirium in Critically Ill Patients. United Kingdom Clinical Pharmacy Association. June. 2006.
Granberg. Malmros. Bergbom. Lundberg. Intensive Care Unit Syndrome/Delirium Is Associated With Anemia, Drug Therapy And Duration Of Ventilation Treatment. Acta Anaesthesiol Scand 2002; 46: 726–731
Sandeep Jauhar .When A Stay in Intensive Care Unhinges the Mind. The New York Times. December 8, 1998.
Richard C. Monks. Intensive Care Unit Psychosis. Canadian Family Physician. Vol. 30: February 1984, P No- 383-389