ICU Delirium Question

[titans221]

I am currently an M1/M2 and am doing a summer research fellowship at a lab that focuses primarily on ICU delirium. It seems that its frequently not diagnosed based on the literature that I've been given to read and based on my talks with the PI. I was just curious as to how frequently it's assessed for based on other people's experiences.

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[Noyac]

Usually not until overtly present.

 

[cchoukal]

ICU delirium is a complex, variable organism. A significant number of patients have delirium that is hypo active, and wouldn't necessarily be overtly present. Both of the ICU practices where I attend do twice daily screens using the CAM-ICU, one of a small group of validated screening tools for delirium. I don't know if this is necessarily a standard of care, so to speak, but it's certainly something the quality box-checkers are paying a lot of attention to.

 

[IveGotTwins]

An entire lab dedicated to ICU delirium?

 

[michigangirl]

An entire lab dedicated to ICU delirium?

ICU delirium is a hot topic. Wes Ely recently visited our insitution for grand rounds, he is the creator of the CAM-ICU. I research pediatric ICU delirium. There is a lot of really great research ongoing at the bench and bedside in this area. The goal is for every ICU patient to be assessed for delirium Q12hours as cchouka stated is done in their unit. Some resources for those who are interested:

Vanderbilt's website-- great educational tools and resources for adult and pediatric ICU delirium: www.icudelirium.org

Review Article in NEJM: http://www.nejm.org/doi/full/10.1056/NEJMra1208705

There was a whole supplement in Critical Care Medicine dedicated to pain, agitation and delirium guidelines:
http://journals.lww.com/ccmjournal/toc/2013/09001

 

[Ezekiel2517]

ICU delirium is a complex topic. It is assessed for daily and can be done quickly using CAM-ICU. Problem is even twice a day may not be enough as delirium has a very fluctuating course. Also, the hypoactive form is just as prevalent as hyperactive, if not more. Hypoactive is harder to detect and treat and is associated with worse outcomes. Seriously, what the hell am I supposed to give for hypoactive delirium? I am not a fan of the use of Seroquel and similar drugs which are commonly started in the ICU for delirium. Too many pts end up being discharged on these meds and taking them long term, when their delirium would have likely resolved on its own, even if untreated.

 

[titans221]

ICU delirium is a hot topic. Wes Ely recently visited our insitution for grand rounds, he is the creator of the CAM-ICU. I research pediatric ICU delirium. There is a lot of really great research ongoing at the bench and bedside in this area. The goal is for every ICU patient to be assessed for delirium Q12hours as cchouka stated is done in their unit. Some resources for those who are interested:

Vanderbilt's website-- great educational tools and resources for adult and pediatric ICU delirium: www.icudelirium.org

Review Article in NEJM: http://www.nejm.org/doi/full/10.1056/NEJMra1208705

There was a whole supplement in Critical Care Medicine dedicated to pain, agitation and delirium guidelines:
http://journals.lww.com/ccmjournal/toc/2013/09001

I'm actually participating in their research group. Wes is an awesome guy; super friendly and incredibly knowledgeable.