2. 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.
3.
4. 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.
5. 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.
6. 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
7. 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
9. 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
10. 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.
11.
12. 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.
14. 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
15. 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