General Education

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Summary of Non-pharmacological interventions for delirium prevention and management

Delirium Hidden Dangers & Beyond (12 minutes)

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VA Agitated Behaviors Among Older Hospitalized Patients

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What is Delirium?

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4AT: The 4AT is a validated rapid assessment test for delirium and cognitive impairment. It is widely used in routine clinical practice in the UK and internationally.

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Confusion Assessment Method-ICU Form & Instructions: The CAM-ICU is a delirium monitoring instrument for ICU patients. A complete detailed explanation of how to use the CAM-ICU, as well as answers to frequently asked questions and case studies are provided a manual. More information including videos and materials for downloading are available at ICU Delirium.

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The UB-CM Training Manual

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What is Delirium

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A Waking Nightmare for COVID-19 Patients: In a new documentary coronavirus survivors describe frightening experiences in the intensive care unit. Respiratory failure known as ARDS (acute respiratory distress syndrome) that effects the most critically ill COVID-19 patients requires mechanical ventilation and up to 80% of patients on a ventilator will develop ICU delirium. One in 4 ARDS survivors will also develop PTSD. Many COVID patients describe nightmares, depression, and anxiety after their hospitalizations. Delirium is a strong predictor of adverse cognitive, physical, and psychological outcomes for ICU survivors. These problems called PICS (post-intensive care syndrome) that ICU patients can experience post-discharge affects up to 33% of patients on ventilators and 50% of patients who stay in the ICU for at least one week. Dr. Wes Ely, a professor of Pulmonary and Critical Care Medicine at Vanderbilt University School of Medicine states that “If you had to design an experiment to make delirium as bad as it could be, COVID is it. COVID is essentially a delirium factory”.

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Why a stay in the ICU can leave patients worse off: Almost 6 million patients are admitted to an intensive care unit every year and for many it will mark a turning point in their lives. While one-third will return to normal, two-thirds will not return to their baseline or will decline even further. This is a substantial number of patients who are leaving the ICU facing many negative outcomes including anxiety, dementia, depression, and muscle and nerve problems. Some ICUs have developed new standards to decrease prolonged ventilation and increase mobility as a way to improve outcomes for these patients. As Dr. Wes Ely, a professor of Pulmonary and Critical Care Medicine at Vanderbilt University School of Medicine explains “We’re trying to get back to the humanness of critical care”.

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