Intensive Care Unit Delirium and Intensive Care Unit-Related Posttraumatic Stress Disorder

Abstract

Delirium is one of the most common behavioral manifestations of acute brain dysfunction in the intensive care unit (ICU) and is a strong predictor of worse outcome. Routine monitoring for delirium is recommended for all ICU patients using validated tools. In delirious patients, a search for all reversible precipitants is the first line of action and pharmacologic treatment should be considered when all causes have been ruled out, and it is not contraindicated. Long-term morbidity has significant consequences for survivors of critical illness and for their caregivers. ICU patients may develop posttraumatic stress disorder related to their critical illness experience.

Keywords: Brain dysfunction; Critical illness; Delirium; ICU-related PTSD; Intensive care unit; Long-term cognitive impairment; Posttraumatic stress disorder.

Figure 1

Cardinal symptoms of delirium. From Morandi et al. Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients. Intensive Care Med. 2008 Oct;34(10):1907–15, with permission. Morandi et al. Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients. Intensive Care Med. 2008 Oct;34(10):1907–15. doi: 10.1007/s00134-008-1177-6. Epub 2008 Jun 18. (2) Reprinted with permission

Figure 2

Richmond Agitation-Sedation Scale (RASS) and Riker Sedation-Agitation Scale (SAS). Data from Babar A. Khan, Oscar Guzman, Noll L. Campbell, et al. Comparison and Agreement Between the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale in Evaluating Patients’ Eligibility for Delirium Assessment in the ICU. Chest. Volume 142, Issue 1, July 2012, Pages 48–54.

Figure 3

Confusion Assessment Method for the ICU (CAM-ICU). From http://www.icudelirium.org/docs/CAM_ICU_training.pdf, page 8.

Figure 4

Sample Delirium Protocol. From http://www.icudelirium.org/delirium/management.html.

Figure 5

Risk factors for post-ICU psychological outcome. From McGiffin JN et al., Is the intensive care unit traumatic? What we know and don’t know about the intensive care unit and posttraumatic stress responses. Rehabilitation Psychology, Vol 61(2), May 2016, 120–131, with permission. ICU Intensive Care Unit, PTSD Posttraumatic stress disorder. McGiffin JN et al., Is the intensive care unit traumatic? What we know and don’t know about the intensive care unit and posttraumatic stress responses. Rehabilitation Psychology, Vol 61(2), May 2016, 120–131. http://dx.doi.org/10.1037/rep0000073, American Psychological Association, (87). Reprinted with permission