Critical Care Trauma Centre

Delirum

Delirium is a very common problem among critically ill patients, particularly among older adults or those with risk factors such as brain injury or chronic alcohol use.  It is sometimes called "acute brain failure". Critical illness, infection, discomfort and medications are a few of the many possible factors that can increase the chance of developing delirium. Delirium can lengthen the duration of both the critical care and the hospital length of stay, make it more difficult for the patient to breathe without a ventilator, and puts the patient at risk for self-removal of life-saving tubes and equipment.

While some delirious patients may be agitated or paranoid, others can appear “flat” and non-responsive. Patients may hallucinate and interpret real situations in bizarre ways (e.g. it is common for patients to think that staff members are trying to harm them). Family members may be the first to notice subtle changes in the patient’s behavior.

Delirium is not a disease itself. Rather, delirium is a complication that occurs because of an acute medical or psychiatric problem.  Severe infection is a problem that is frequently associated with delirium.  We don't really know if delirium increases a patient's risk to do poorly, or whether delirium is just one of the body systems that stop working properly during a critical illness.

While some patients recover fully, other patients may never return to the same level of cognitive function (thinking ) as before their hospitalization.  The risk for long term changes in brain functioning may be highest in older patients, patients who remain delirious for a prolonged period of time and/or patients with other chronic health problems.

CCTC participated in a national critical care initiative aimed at the prevention, recognition, and early treatment of delirium. Family members may be able to help prevent or minimize delirium through the following strategies:

  • Provide accurate accounts of your family member's home medications or alcohol use
  • Tell us about your family member's normal routines
  • Supply corrective eyewear and/or hearing aids as soon as your family member is awake. Do not bring dentures until the patient is off the breathing tube.
  • Bring items that are familiar to your family members such as a favourite pillow or blanket , face soap and shampoo.
  • Complete the About Me poster and Help us to Get to Know our Patient questionnaire
  • Personalize your family member's room with family photos.
  • Provide headsets with your family member's favourite music or relaxation tapes
  • If a tablet or computer is available, family movies can help keep a patient connected to those unable to visit
  • Orient your family member to the date and time of day with each visit and remind them of the reason for admission 
  • Be careful to avoid overstimulation. 
  • Post calendars and clocks within your family member's line of vision
  • Speak to your family member in a calm and reassuring manner during visits, and remind him/her of the location and reason for hospitalization
  • Avoid overwhelming a patient with large numbers of visitors, or loud/excitable visits
  • Promote day and night routines; lights on during daytime (except afternoon nap) and quiet, dark nighttime environment with minimal interruptions
  • Some delirious patients will become more relaxed with a calm and quiet family member at the bedside; speak to the nurse at the bedside regarding the most effective approach for your family member.


     

Last Reviewed: October 31, 2018