The challenges of preventing ICU delirium with patients in isolation

Part of Philips patient monitoring educational series about supporting care of patients with COVID-19, this webinar provides information about the challenges associated with ICU delirium in patient in isolation.

[nickykock]

My mom sadly passed on of Covid, after being admitted to hospital for a heart attack. It was hard for me to understand that my mom, a healthy, wise, strong minded woman even at the age of 80, became aggressive when the medical team wanted to put her on a ventilator. Though they explained she seemed confused at the time, I couldn't help but believe my brother and my presence would have helped her feel better, get better, but ofcourse we weren't allowed to be with her. Even though I would have given my last breath just to be with her, tell her how much we love her, thank her, hold her hand in those last few moments. There must be ways to close the gap between loved ones especially during this crucial time. Whether it be plastic tunnels leading to the patients bed with mics in them etc. I may not have a solution but I believe that narrowing the gaps between loved ones will aid in more lives being saved.

[_Breakdown]

4:47 - - Delirium defined - -
6:30 - - Hypoactive; withdrawal, apathy, lethargy +/or decreased responsiveness; appears as if they're sleeping - -
8:07 - - Risk factors - - 9:22 - - Healthcare providers unknowingly harm patients - -
9:39 - - Patients w/delirium are more likely to experience negative outcomes - -
9:50 - - Increased hospital stay, hospital-associated complications, prolonged vent weaning, physical de-conditioning/impairments; leads to needing long-term care / rehab after discharge; higher re-admission rates; short/long-term cognitive impairment (including dementia; even if delirium clears); increased mortality risk in hospital; and 6-12 months after leaving; higher risk for Post-ICU Syndrome (PICS) - -
(*)17:01 - - Family engagement & empowerment - - 19:01 - - Challenges of preventing delirium - -
26:28 - - There's a lack of knowledge of delirium + healthcare providers still think there are no long term effects - -
26:41 - - Results in delayed treatment - - 28:04 - - Study - - patients in isolation have 23% less family visitors - -
(*)28:20 - - See chart - - Non-COVID patients are to receive LESS visitors (COVID patients are not allowed any visitors) - -
(*)28:46 - - Use the SAME safety protocols for past 20 years; these protocols were ignored b/c of initial COVID fears - -
30:44 - - Anti-psychotic meds don't work; benzodiazepines have shown to make delirium worse - -
32:14 - - Solutions - - SUPPORTIVE MEASURES are the most realistic to implement - -
33:42 - - Healthcare workers are placing pictures of themselves on their gowns - -
33:53 - - Have a clock + calendar in the room - -
(*)34:18 - - ENGAGE FAMILY - - Bring items from home - -
34:46 - - Provide educational material on delirium - including at discharge / follow-up care may be needed - -
34:56 - - Cognitive stimulation - puzzles, cards, games, crossword puzzles, word-finds, coloring books, etc - -
35:03 - - Decrease noise - - adjust VOLUME of alarm settings, be aware to SHUT OFF alarms ASAP (i.e. repetitive beeping when feeding tube alarm is finished b/c it can be very irritating to patients) - - it will decrease PPE (Personal Protective Equipment) and promote rest - - adjust LIGHTING - - adjust FANS for patient comfort (be sure fans are not directly on patients, or are on an oscillation mode) - -
35:24 - - Guide of intervention procedures from HELP (Hospital Elder Life Program) - -
36:13 - - China + Italy reported a significant increase in delirium associated with COVID patient hospital isolation - as well as after being discharged - -
36:35 - - PICS (Post Intensive Care Syndrome) - new or increased physical, cognitive/mental impairment after discharge from the ICU/CCU - -
37:05 - - PICS related impairments produce depression, anxiety, PTSD - - and can result in dementia (≠ reversible) - -
37:41 - - 1/4 of patients discharged require assistance in activities of daily living (ADL) a year after ICU admission - -
39:07 - - ICU delirium + PICS are getting more attention in news - -
39:34 - - Recent stories of effects of delirium in covid/isolated patients AFTER discharge = PTSD - - including an RN - -
40:21 - - Brief testimonials of patients who recovered from delirium - - including a doctor - -
(*)40:53 - - BEST SOLUTION - - Isolated patients NEED THE PRESENCE & CONTACT OF FAMILY & LOVED ONES !!!
41:30 - - Further resources on ICU delirium - -
(*) Dr. Wes Ely - - Highly experienced Pulmonary/Critical Care MD prescribes family contact for patients w/delirium:

[dukezinnia]

This is scary and good to know. I don't have any medical background. But I'll remember this if it ever becomes relevant. My family is just staying at home being very cautious and things like this justifies it.

[younanm]

WHAT an important topic.. so underestimated and ignored.. killed my father