Acute Care/Hospitalization

More education is needed to improve delirium and sedation management in intensive care units

Patients in intensive care units (ICUs) can develop delirium due to factors ranging from ICU stress, multiple drugs, interrupted sleep, and their fragile state. Delirium can include inattention, disorganized thinking, hallucinations, and other altered mental states. Since delirium can increase the risk of mortality, longer hospital stays, and other negative outcomes, its management is important. Although ICU providers believe delirium can adversely affect patient outcomes, they often do not manage the condition properly, reveals a new study.

Researchers surveyed 1,384 health care professionals working in ICUs about their beliefs and practices regarding ICU delirium and sedation management. These included physicians, nurses, respiratory care practitioners, and others. They compared results with an older 2001 survey, in which providers considered delirium a serious problem. The current study found that the majority (59 percent) of providers surveyed estimated that one in four patients on a ventilator experienced delirium. A similar percentage of doctors (59 percent) screened for delirium. Although only a third (33 percent) of those screening patients used a specific screening tool, this was nearly 3 times the 12 percent of doctors who used a specific screening tool in the earlier survey. Unlike the 2001 survey, this new study also inquired about sedation methods and the use of spontaneous awakening trials (SATs) where patients are taken off sedation drugs for a day.

Nearly a third (29 percent) of respondents said they did not use a specific sedation protocol. Although the majority (76 percent) had written policies on SATs in place, less than half (44 percent) implemented these awakening trials on more than half of the days the patient was in the ICU. The study was supported in part by the Agency for Healthcare Research and Quality (HS15934).

See "Delirium and sedation in the intensive care unit: Survey of behaviors and attitudes of 1384 healthcare professionals," by Rina P. Patel, S.B., Meredith Gambrell, B.A., Theodore Speroff, Ph.D., and others, in the 2009 Critical Care Medicine 37(3), pp. 825-832.

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