​​​​​​Delirium is a condition that affects the brain. It often shows up suddenly, within hours or days. Some features of delirium include having trouble focusing (called inattention), sudden changes in behavior, and confusion. For most people, delirium doesn’t last long – usually only a few days.

There are many reasons for someone to develop delirium such as infection, certain medicines and problems with blood sugar. People who are in an intensive care unit (ICU) are at risk of developing delirium, called ICU delirium. About 2 out of 3 patients in the ICU develop delirium, and those on breathing machines tend to be most at risk. ​In 2015 and 2016, Alberta reported 41% of adult patients in the ICU developed delirium.

It’s important to diagnose and treat ICU delirium as quickly as possible. Research shows that patients with ICU delirium have poor outcomes if they leave the hospital without treatment (this is not common). This can lead to long-term problems with brain function, muscle weakness, and not being able to maintain the same quality of life as they did before they were in the intensive care unit. Depression and anxiety are the most common long-term problems experienced by patients diagnosed with ICU delirium.

​​​​​​​​​​​​​​There may be more than one cause or risk factor for ICU delirium, such as:

• being older than 65 years
• low oxygen levels in the brain
• the brain isn’t using oxygen properly
• chemical changes in the brain
• certain medicines, such as sedatives or painkillers
• infection
• pain
• having an illness
• alcohol use
• withdrawal from alcohol or nicotine

​​The ICU healthcare team knows how to look for signs of delirium, even if your loved one can’t talk. They watch for changes in attention, behavior, sleeping patterns, and other signs. They use a tool called the Intensive Care Delirium Screening Checklist. But ICU delirium can still be hard to diagnose. Studies show that 1 out of 3 cases may go unnoticed.

While the healthcare team does their best to look for signs of delirium, they don’t know your loved one as well as you do. That’s why it’s important for you to let us know if something doesn’t seem right with your loved one while they are in the ICU.

To help the healthcare team assess for delirium, they may ask you questions about your loved one’s medical history and what they were like before they came to the hospital.

​​​There are short-term and long-term outcomes of ICU delirium.

Short-term outcomes include:

• changes to how a person acts or looks
• longer hospital stays
• needing to be on a breathing machine for longer
• more stress on families and caregivers
• higher costs related to care

Long-term outcomes include:

• depression, anxiety, and post-traumatic stress disorder
• trouble thinking, concentrating and remembering
• trouble with daily activities
• having to move to a care facility

It’s important to let the healthcare team know if your loved one has any sign of delirium.

​​​You know your loved one best. Sharing information about who your loved one is and what they like can help us give them the best care. Having you there with them brings them comfort, even if you can’t tell. You can also bring your loved one comfort by doing the following:

• let the nursing team know your loved one’s preferences
• share with your nursing team who they are as a person outside of the ICU
• bring in their glasses, hearing aids, and other items they use
• talk in a calm voice and keep conversations simple
• try to keep their attention by reading to them, playing music, rubbing their hands, or praying with them
• tell them about current events and talk about family members and friends
• bring in 1 or 2 of their personal items from home
• let them know the date, time, and where they are
• help them with daily activities such as brushing their teeth, washing their face and other activities you’re comfortable helping with
• open blinds during the day to allow natural light in the room or turn lights on
• set up how they like to sleep at night such as using certain blankets, having dim light or making sure they have earplugs

​​​​​​​If your loved is diagnosed with ICU delirium, the next step is to try to find out what may have caused it. Sometimes we don’t know what has caused the delirium. There are some strategies your ICU team may look at to help your loved one’s symptoms. They may:

• treat any medical causes for the delirium, such as an infection or withdrawal
• review the medicines your loved one is taking. It is possible that some of these medicines may be causing the delirium
• make sure pain is assessed and treated. Pain may be treated with medicines or non-medicine therapy such as massage or relaxation techniques
• assist your loved one with daily breathing exercises (if the patient is on a breathing machine)
• provide your loved one with a special physiotherapist – they are healthcare providers who are trained to move ICU patients. They will assess your loved one’s ability to move safely (by sitting at the beds or in a chair, for example). This kind of movement will improve their breathing and muscle strength
• try to encourage a regular sleep routine to help reduce day/night confusion
• involve patient families in daily care and encourage involvement in all the activities listed above

​​​​​​​​The ICU is a busy and stressful environment. You will have many questions. Sometimes it is helpful to write them down, as you may think of something after your visit that you would like to ask the team. The healthcare team of nurses, doctors, respiratory therapists, occupational and physiotherapists, dieticians, pharmacists, social workers, spiritual care advisors and specialists there to support you and your loved one.

Please speak to a member healthcare team if you need more information or support. There is a lot of great information available online and your healthcare team would be pleased to answer your questions and help you identify credible resources.

The following websites have current and up-to-date information about ICU delirium and intensive care.

Vanderbilt University

ICUdelirium.org

Vanderbilt University is a leader in research and up-to-date information about intensive care delirium. The website has videos of patients who talk about the long-term impact of ICU delirium.

You can also learn about what to ask your loved one’s doctor.

Intensive care booklet

ICUsteps.org

An excellent patient and family resource that you can download. https://icusteps.org/assets/files/IntensiveCareGuide.pdf

Society of Critical Care Medicine THRIVE

myicucare.org

This organization helps ICU survivors and their loved ones learn more about Post-Intensive Care Syndrome. This website includes information about peer support, frequently asked questions, and has resources for patients and families.

MyHealth.Alberta.ca

MyHealth.Alberta.ca also has more information about delirium.

• ​​​​​​​Critical Care SCN Patient and Family Advisors​
• ​​​​​​​​​ICUdelirium.org
• ICUsteps.org
• Society of Critical Care Medicine THRIVE website
• University of Calgary and AHS created patient and family brochure
• Barr J, Fraser GL, Puntillo K, et al; American College of Critical Care Medicine: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41:263-306
• Zaal IJ, Devlin JW, Peelen LM, et al: A systematic review of risk factors for delirium in the ICU. Crit Care Med 2015; 43:40-47