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Published online by Cambridge University Press: 05 December 2011
Introduction
How to detect delirium in the critically ill patients even when they are sedated? Don't worry, it is easy… but only if you look for it. Most patients present with hypoactive delirium, a lethargic apparently co-operative patient; but just scratch the surface and you will find an inattentive patient with altered mental status and disorganized thinking.
A 69-year-old patient was recovering from an infection of his urinary tract that had led to major sepsis. He still required haemofiltration intermittently and consequently was only mobilizing slowly. He appeared as a quiet and co-operative patient, but was extremely reluctant to eat. The clinicians and dietician made sure he was not constipated, and prescribed nutritional supplements while encouraging him to eat. The team suspected he was depressed. It was only after discharge, when he was seen in the follow-up clinic, that he told the consultant that he had been frightened whilst on the unit, believing that the staff were feeding him up so they could eat him for Christmas! The ICU staff had no idea.
Delirium screening is recommended routinely for all critically ill patients. It doesn't need any equipment, there is no risk to the patient and takes around 2 minutes (if that),… how many interventions in ICU are so quick and easy?
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