Critical Matters Deep Dive in Delirium
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Jun 12, 2019 Wesley Ely, a professor of medicine at Vanderbilt University and co-director of the CIBS Center, dives into the critical impact of delirium on ICU patients. He discusses innovative assessment methods like the CAM-ICU and highlights the long-term cognitive risks, including dementia, following ICU stays. Ely emphasizes non-pharmacological strategies to enhance patient environments and improve outcomes, such as natural light and physical activity. Communication during patient transitions is also crucial, advocating for structured care approaches to manage delirium effectively.
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Core Definition: Attention Failure
- Delirium is fundamentally an inability to pay attention measured by brief tasks like the CAM-ICU attention test.
- Even without hallucinations, poor attention is a sensitive marker that the brain is not working normally.
Delirium Predicts Major Outcomes
- Days spent delirious independently predict four major outcomes: higher mortality, longer stays, higher costs, and accelerated acquired dementia.
- Delirium duration is a strong prognostic marker, not just a transient nuisance.
Young Survivor's 'Cobwebs' Description
- A 27-year-old ARDS survivor told Dr. Ely her "brain just doesn't work the way it used to" after ICU delirium.
- She described memory and executive dysfunction that impaired her job performance and daily life.
