Icu psychosis

Icu psychosis

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  ICU SYNDROME/ICU PSYCHOSIS Presented by BasilKuriakose
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  INTRODUCTION  Advances inmedical science and technology have prompted the establishment of many highly specialized units (ICUs) providing intensive patient care.  ICU psychosis /Delirium in the intensive care unit is a serious problem that has recently attracted much attention.  As the number of intensive care units and the number of people in them grow, ICU psychosis is perforce increasing as a problem.
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  DEFINITION  Eisendrath defined"ICU Syndrome" /"ICU psychosis" as an acute organic brain syndrome involving impaired intellectual functioning and occurring in patients treated within a critical care unit.
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  INCIDENCE  It iscommonly found in the critically ill with a reported incidence of15-80%  By some estimates, 80% of elderly intensive-care patients develop the condition, which frequently leads to nursing home stays and a hastened death.
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  ETIOLOGY AND PREDISPOSING FACTORS  Sensory overload  Sleep deprivation  Immobilization  Severe emotional stress  Unfamiliar environment  Dehydration  Low Hemoglobin level  Hypoxemia  Pain  Infection  Drugs  Prolonged stay in ICU and advancing age
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  CLINICAL MANIFESTATIONS Sudden onsetof impairment in cognition  Disorganized thinking  Difficulty in concentrating  Problems with orientation in time and/or place and/or person  Altered affect, often with emotional liability  Altered perception of external stimuli  Impairment of memory  Changes in sleep–wake cycle  Hallucinations  Agitation or change in activity levels
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  DIAGNOSTIC EVALUATION  ConfusionAssessment Method  Mini mental status examination  Explore other organic causes
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  MANAGEMENT  The managementstrategy is to “wait and watch”. Non Drug Management  Continuity of health care personal  Clear concise communication  Repeated verbal reminders of time, place and person.  Clock, calendar, TV, newspaper, radio readily accessible as a means of orientating in time
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   Simplify theenvironment, single room when available, reduce noise levels, remove unnecessary equipment  Adjust lighting according to day and night cycle.  Keep familiar objects  Flexible visiting hours  Allow maximum periods of uninterrupted sleep  Encourage mobilisation and increase activity levels  Relaxation techniques like music therapy and massage may also help.
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  PHARMACOLOGICAL MANAGEMENT  Antipsychoticagents such as haloperidol is commonly used.  Olanzapine and respiridone have been used as they are less sedating and have fewer side effects  Benzodiazepine would be beneficial, and lorazepam is the drug of choice.
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  OTHER THERAPEUTIC MEASURES Adequate pain management  Avoid offending drugs  Correct fluid and electrolytes  Treat infection  Administer oxygen  Correct hypoglycemia  Treat underlying cardiac problems
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  ASSIGNMENT  Do aconcealed observation of your ICU and find out things and factors that can be avoided to prevent ICU syndrome also suggest some measures to prevent ICU syndrome.  Formulate a scale to assess ICU syndrome
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  REFERENCES  Lewis, Heitkemper,Dirksen O’Brien, Bucher. Medical Surgical Nursing. Seventh edition. Nodia: Elsevier publication; 2007.p no-1576-78,1736-37.  Mark Borthwick. Richard Bourne. Mark Craig. Annette Egan. Prevention and Treatment of Delirium in Critically Ill Patients. United Kingdom Clinical Pharmacy Association. June. 2006.  Granberg. Malmros. Bergbom. Lundberg. Intensive Care Unit Syndrome/Delirium Is Associated With Anemia, Drug Therapy And Duration Of Ventilation Treatment. Acta Anaesthesiol Scand 2002; 46: 726–731  Sandeep Jauhar .When A Stay in Intensive Care Unhinges the Mind. The New York Times. December 8, 1998.  Richard C. Monks. Intensive Care Unit Psychosis. Canadian Family Physician. Vol. 30: February 1984, P No- 383-389