Healthcare News & Insights

Study: Reduced hospital-acquired delirium in intensive care

Did you know hospital-acquired delirium is a big problem in the intensive care unit (ICU)? 

118153855In fact, researchers estimate that at least 45% of patients in the ICU develop hospital-acquired delirium. And that number can reach more than 80 percent for ICU patients who require mechanical breathing assistance. Add to that being elderly and the risk increases.

As if that isn’t bad enough, patients with delirium tend to die more frequently than others during the first 12 months after they’re discharged, and their delirium tends to linger.

Real-life story

Take for instance Mark Halliday, a 62-year-old student in the Master of Social Work program at Rutgers University, who was hospitalized with a diabetes-related infection in his leg. According to Rutgers Today, within a mere 24 hours of being hospitalized, Halliday’s heart rhythm became irregular, he developed sepsis and wound up in the ICU where he was intubated and sedated to make it more tolerable.

The experience was so stressful, on top of his illness, that his mental functions declined and he became delirious and ripped out his tubes. This required him to be restrained and given antipsychotic medication.

Beth Halliday, Mark’s wife, said her husband still has significant short-term memory loss, and while he is back to work, he hasn’t returned to the university to finish his studies.

Protocols to prevent delirium

Due to patients like Mark, physicians on the faculty of Rutgers New Jersey Medical School are studying delirium among patients in the surgical ICU at University Hospital in Newark, the school’s primary teaching facility.

Their main goals are to prevent delirium and reduce the length of time delirium lingers. Reason: Studies show that for every day that a patient remains delirious, the risk of lasting damage rises.

One technique being used to prevent delirium is regularizing patients’ sleep-wake cycles, which in the ICU is hard to do since many patients require frequent physical exams. The goal is for the patient to have at least two 90-minute periods each day of undisturbed rest. That means some care that was given around the clock, is now reserved for daytime. And when possible, patients receive less sedation.

The use of physical restraints is also being re-evaluated. While the use of restraints is meant to keep patients from hurting themselves, their use causes agitation and delirium in some patients, making everything worse.

Finally, since patients often lie in bed all day after major surgery, the researchers are trying to make the patients as physically mobile as possible. To accomplish this, students in the Doctor of Physical Therapy program at Rutgers School of Health Related Professions visit the unit one morning each week.

The students, who are supervised by physical therapy faculty, take the patients through a series of exercises designed to make them more alert. Also, patients are encouraged to move their limbs in bed and, when physically able, to sit on the edge of the bed and get up and walk.

Teaching family members how to keep their loved ones more active between physical therapy sessions is also part of the protocol.

So far, so good

From the data the researchers have collected so far, the protocols are having a positive effect on treating delirium.

“Patients in the unit who developed delirium were delirious for a shorter amount of time,” noted Anne Mosenthal, chair of New Jersey Medical School’s Department of Surgery. “We don’t know whether that’s because of the physical therapy, the sleep-wake cycle or our using less sedation, but all of that together seems to have made a difference.”

Marsha Atkind, executive director of the Healthcare Foundation of New Jersey, which is funding the program, is pleased with what she has seen. “I think they are really changing the culture of care for older adults.”

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