Delirium in the ICU

Abstract

Delir ium is a disturbance of consciousness delirium. However till recently, the diagnosis of delirium characterized by acute onset, rapid fluctuations in mental in the ICU was imprecise and not standardized, leading status and impaired cognitive functioning. The patient’s to wide variations in the incidence of delirium in various ability to receive, process, store and recall information studies and difficulty in interpreting their results. Recently, is strikingly impaired. The patient may be agitated or the confusion assessment method has been refined and lethargic. It is perhaps better known by its synonyms validated for use in ICU patients, the CAM-ICU. This including intensive care unit (ICU) psychosis, acute can be performed at the bedside and takes less than confusional state, toxic encephalopathy organic brain two minutes. Changes in mental status are best determined using the Richmond Agitation-Sedation Scale (RASS). This is superior to the Glasgow Coma Delirium is unfortunately often regarded as ICU score or other sedation scores as it also includes eyepsychosis or a behavioural disturbance due to the contact, rather than eye-opening alone, in the environment in the ICU. However, the mnemonic for the assessment. Inattention is determined by responses differential diagnosis I WATCH DEATH (Infections, to the attention screening examination (ASE), in which Withdrawal, Acute metabolic encephalopathy, Trauma, the patient has to identify cards previously shown to him. central nervous system (CNS) pathology, hypoxia, Disorganized thinking is detected by answers to four deficiencies, endocrine disorders, acute vascular standard questions or inability to follow simple insufficiency, toxins and drugs, Heavy metals) is commands. testimony to the fact that delirium may be the symptom of a serious underlying life-threatening disorder. The Using the CAM-ICU, Ely et al found delirium to be article by Rudra et al in this issue of the Indian Journal present in 40% patients who appeared alert or rousable of Critical Care Medicine[3] is timely and important and in 80% of all mechanically ventilated patients.[5] because in reviewing the subject of postoperative delirium, it also draws attention to the larger problem of The diagnosis of delirium requires the presence of syndrome, etc.