Intensive Care Unit Psychosis Research Articles

Intensive care unit psychosis after cardiac surgery

Background: Postoperative psychosis after cardiac surgery is associated with increased morbidity, length of hospital stay, and mortality. We aimed to assess the risk factors and outcomes of postoperative psychosis after cardiac surgery. Methods: This research is a retrospective observational case-control study that included 100 patients divided into two groups. Group 1 included 50 patients with postoperative psychosis, and Group 2 included 50 patients with no postoperative psychosis. Data were collected from the Cardiac Surgery Department database from October 2020 to April 2021.
 Results: The mean age was 67.94 ± 11.69 years in patients with psychosis and 68.98 ± 10.19 years in the control (P= 0.636). Males patients presented 66% (n= 33) in patients with psychosis versus 70% (n= 35) in the control group. Cardiopulmonary bypass (144.9 ± 35.61 vs. 109.1 ± 17.19 min, P˂0.001) and ischemic times (61.96 ± 15.93 vs. 50.52 ± 9.62 min, P˂0.001) were significantly longer in patients with psychosis. The mean arterial pressure (MAP) (61.93± 13.44 vs. 80.78 ± 5.91 mmHg, P˂0.001) and oxygen saturation (79.82 ± 8.81 vs. 90.12 ± 4.91%; P˂0.001) were significantly lower in patients with psychosis. Central venous pressure was 11.76± 2.33 in patients with psychosis versus 3.58± 1.70 mmHg in the control group (P˂0.001). ICU was significantly longer in patients with psychosis (4.82 ±2.14 vs. 1.62 ± 0.55 days; P˂0.001), while there was no difference in the hospital stay. By multivariable analysis, lower MAP was an independent predictor of postoperative psychosis (OR: 0.930 (95% CI: 0.737–0.999), P= 0.045).
 Conclusion: Low mean arterial pressure could predict postoperative psychosis. Proper blood pressure control could decrease the incidence of psychosis after cardiac surgery.

Enhancing nurses’ resilience, knowledge, and perception regarding intensive care unit psychosis.

Enhancing nurses’ resilience, knowledge, and perception regarding intensive care unit psychosis.

Intensive care unit delirium - does prolonged intensive care unit stay increase morbidity

<p class="abstract"><strong>Background:</strong> The term intensive care unit (ICU) delirium or ICU psychosis denotes the transient period of psychosis exhibited by the geriatric patients placed in long term ICU care. This condition can be mistaken for organic neurological deterioration and can result in improper treatment, delayed rehabilitation and longer ICU stay. The objective of the study was to analyse the outcome of early ward rehabilitation in post-surgical patients with ICU psychosis.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective case control study of 45 geriatric patients (above 60 years of age) who developed delirium or psychosis after long term ICU stay (>4 days) following a major trauma and orthopaedic procedure. Of the 45 patients, 28 patients (group A) were shifted out of ICU after haemodynamic stability despite continued delirious episodes. The remaining 17 patients (group B) were those who were retained in the ICU for complete neurological recovery.<strong></strong></p><p class="abstract"><strong>Results:</strong> Significant positive difference was noted in patients who were shifted out of ICU early (group A) compared to group B. Group A patients had faster recovery, lesser delirious episodes (2.3±0.9 compared to 13.4±2.7) and fewer days of hospital stay (4.9±1.2 compared to 12.4±2.6) when compared to group B. None of the patients had any episodes of psychosis after discharge from the hospital when followed up for duration of 6 months.</p><p class="abstract"><strong>Conclusions:</strong> Post-operative geriatric patients diagnosed with ICU psychosis fare better with early out of ICU mobilisation. It is not essential to wait for full neurological recovery to shift these patients out of ICU though close ward monitoring may be essential in some cases.</p>

Study of Delerium and Its Subtypes in Medically Ill Hospitalised Patients

Introduction A multitude of terms are used to describe delirium, including encephalopathy, acute brain failure, acute confusional state and post-operative or intensive care unit psychosis, essentially it is defined as a relatively acute decline in cognitions that fluctuates over hours or days. There are two broad clinical categories have been described -hyperactive and hypoactive subtypes;that are based on differential psycho-motor features. A possible neuro-inflammatory basis for delirium is emerging and low levels of IGF-1 have recently been found as a risk factor for delirium. Acute phase reactant C-RP has been used as a marker of inflammation may also be implicated in the cause and outcome of delirium. Aims and Objectives 1) To study the prevalence of various subtypes of delirium in medically ill hospitalised patients. 2) To test C-RP as predictor of delirium and recovery from delirium as part of preliminary observational study. Methodology This is a cross-sectional study of descriptive and explorative design conducted at JSS Hospital, Mysore. A total of 113 patients were taken for the study and Patients who were admitted to ICU were assessed within 3 days of admission with 1) A standard bedside test of cognitive function, the MMSE(Mini Mental State Examination) 2) The Confusion Assessment Method(CAM) to determine the presence or absence of delirium. 3) The acute physiological score of APACHE-2,to measure the severity of acute physical illness. 4) Delirium Rating Scale. 5) C-RP was measured routinely along with other routine ICU investigations in all acute admissions. Results of the study The study is still being done in the hospital. Hence, the results will be presented during oral presentation in the conference.

Intérêt de l’évaluation quantitative des sources d’inconforts en réanimation

Potential sources of discomfort or stressors associated with an intensive care unit (ICU) stay can be classified as intrinsic or patient-related factors, environmental factors (such as noise and excess of light), and organizational factors. Two approaches facilitate the assessment of ICU-related stressors: first an objective approach by measuring physical or physiological parameters that characterize either ICU-related stressors or their impact on the critically ill patient, and second, a subjective approach using questionnaires (patient-related outcomes). Pain is frequently reported by ICU patients as the main stressful condition, in relation to many therapeutic or diagnostic procedures. Thirst and sleep deprivation are also perceived very negatively by ICU patients in studies based on questionnaires investigating patient-related outcomes. ICU stays without control of stressors may induce agitation and confusion (ICU psychosis) and increase the risk of developing a post-traumatic stress disorder. Promoting the IPREA (Inconforts des Patients de REAnimation, discomfort in critically ill patients) questionnaire and its implementation in routine clinical practice could be the starting point for the development of quality assurance programs based on the Deming Approach—PDCA “Plan Do Check Act.”

Central Nervous System Dysfunction after Noncardiac Surgery and Anesthesia in the Elderly

Central Nervous System Dysfunction after Noncardiac Surgery and Anesthesia in the Elderly

Correlation between serum melatonin circadian rhythm and intensive care unit psychosis after thoracic esophagectomy

Background. Intensive care unit (ICU) psychosis is still a relatively frequent complication after esophageal surgery. We investigated the correlation between ICU psychosis and serum melatonin concentration during the period after esophagectomy. Methods. The study group comprised 41 patients who underwent esophagectomy for treatment of esophageal cancer between 1999 and 2001. The cohort included 36 men and 5 women, aged 36 to 78 years. After surgery, blood samples were collected 4 times a day for 4 days. Serum levels of melatonin were determined with a melatonin radioimmunoassay kit. The regularity of the melatonin circadian rhythm pattern, as defined by the frequency of occurrence of the peak level of melatonin secretion, was determined (the pattern was described as irregular at less than 3 times in the measurement period). Results. Of the 41 patients who met the inclusion criteria, 11 (26.8%) had ICU psychosis develop. These patients were older than those patients in whom ICU psychosis did not develop (P =.01). No significant differences were seen in the duration of surgery, volume of blood loss, term in the ICU, term of intubation, tumor location, disturbances of organ function, and postoperative complications between patients in whom ICU psychosis developed, and those patients in whom it did not. Patients with ICU psychosis tended to have abnormally low serum levels of melatonin. Of the 41 patients studied, 9 (22%) had an irregular pattern of melatonin circadian rhythm. A significant correlation was seen between ICU psychosis and an irregular melatonin circadian rhythm (P =.0001). Conclusion. Irregular patterns of melatonin circadian rhythm may be associated with ICU psychosis. Supplementation with melatonin, or acceleration of melatonin secretion, may protect patients from development of ICU psychosis and may promote recovery to a normal mental state. (Surgery 2003;133:662-8.)

Leech therapy for patients with surgically unsalvageable venous obstruction after revascularized free tissue transfer.

To assess the efficacy and associated complications of a leech therapy protocol used for patients with a head and neck free tissue transfer in whom flap viability is threatened because of surgically unsalvageable venous obstruction. Medical record review of a prospective protocol. Tertiary care academic medical center. Of the 450 free tissue transfers to the head and neck region performed by our microvascular program from January 1, 1995, to October 31, 2000, 8 patients (1.8%) developed venous obstruction not considered salvageable by conventional surgical or thrombolytic therapy. All 8 patients were placed on a protocol using leeches (Hirudo medicinalis), intensive care unit monitoring, antithrombotic pharmacotherapy, frequent hematologic evaluation, blood transfusions as needed, and antibiotic prophylaxis for Aeromonas hydrophila. Flap salvage rate, number of leeches used per patient, time needed for inosculation, duration of intensive care unit admission, transfusion requirement per patient, and complications during leech therapy. All 8 flaps survived with the application of this protocol. An average of 215 leeches were used per patient, and the average time needed for inosculation was 6.6 days. The average duration in the intensive care unit was 9.6 days. The morbidity of our protocol was substantial, with intensive care unit psychosis, prerenal azotemia, and large transfusion requirements being the most frequent complications. An average of 13 U of packed red blood cells per patient was necessary. Aggressive application of the presented leech therapy protocol can salvage free tissue transfers with venous obstruction that are otherwise unsalvageable. The associated morbidity can be marked. Thus, judicious application of this protocol for flap preservation is essential.

Intensive care unit syndrome: a dangerous misnomer.

The terms intensive care unit (ICU) syndrome and ICU psychosis have been used interchangeably to describe a cluster of psychiatric symptoms that are unique to the ICU environment. It is often postulated that aspects of the ICU, such as sleep deprivation and sensory overload or monotony, are causes of the syndrome. This article reviews the empirical support for these propositions. We conclude that ICU syndrome does not differ from delirium and that ICU syndrome is caused exclusively by organic stressors on the central nervous system. We argue further that the term ICU syndrome is dangerous because it impedes standardized communication and research and may reduce the vigilance necessary to promptly investigate and reverse the medical cause of the delirium. Directions for future research are suggested.

Intensive care unit psychosis, the therapeutic nurse-patient relationship and the influence of the intensive care setting: analyses of interrelating factors.

It has been estimated that between 12.5% and 38% of conscious patients admitted to critical care settings experience Intensive Care Unit psychosis, a condition which seems to resolve upon transfer to the ward. This phenomenon was traditionally recognized when the patient outwardly exhibited abnormal behaviours and signs in the form of confusion, delirium, anxiety, depression, delusions and audiovisual hallucinations, yet it has been argued that due to the illness of the patient and their suppressed ability to communicate, such overt displays of unusual behaviour are the tip of the iceberg. In recognizing this phenomenon, it is felt that a relationship exists between Intensive Care Unit Psychosis, the therapeutic nurse-patient relationship, and the environment in which nurses' interactions with their clients occur. This paper will explore the interaction between these three elements while considering the implications for contemporary nursing practice.

Hallucinations following cardiac surgery in a paediatric intensive care unit

Abnormal behaviour as a result of benzodiezapine withdrawal has been reported in children in intensive care. Other causes of abnormal behaviour may be as a result of intensive care unit (ICU) psychosis or delirium. ICU psychosis in adults is well documented but is rarely reported in children, hence this report on a child who suffered hallucinations after cardiac surgery, and discussion on possible causes and the need for greater awareness of this possible complication.