Delirium (ICU psychosis/sundowning)
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| Definition |
Many patients experience an episode
of delirium during their intensive care unit stay. Delirium is
defined by periods of confusion, agitation, and vivid hallucinations
that include both hearing and seeing things that are not real.
Patients developing delirium may become suspicious and paranoid.
Patients will often have increases in their activity, blood
pressure, heart rate and respiratory rate.
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| Causes |
The exact cause of delirium that
occurs in ICU patients is not known. The stress of a critical
illness or injury, major surgery, lack of sleep, medications,
electrolyte abnormalities or infection have all been considered
possibilities. The most likely explanation for a patient's delirium
is usually a combination of factors.
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| Treatment |
The treatment of delirium is
generally aimed at correcting reversible medical conditions and
protecting the patient from being injured. The patient’s agitation
is best controlled with supportive care that includes encouraging a
family member to be present with the patient, allowing the patient
to maximize uninterrupted sleep if possible, keeping the patient's
room well lighted during the day in using a dim light at night,
explaining all procedures in detail, and replacing the patient’s
eyeglasses or hearing aids whenever possible to avoid loss of
sensory cues. If the above measures fail to control the agitation,
medications and temporary soft restraints may be required to protect
the patient from harming himself or herself.
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| Comments |
Delirium may occur in any
hospitalized patient. Delirium is often referred to as ICU psychoses
or sundowning. In general, delirium is a very frightening condition
for a patient, patient's family or friends to endure. Fortunately,
patients themselves do not remember the period of delirium. Delirium
is typically worse during the early evening hours and improves in
the morning hours. Delirium improves with support, time and
improvement of the underlying conditions. Some patients require days
to months to fully return to normal.
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| Related
Links |
National Library of Medicine
The National Library of Medicine presents information about
delirium.
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ICU Medical Conditions 
