Delirium is a condition that affects a patient’s thoughts, perceptions and levels of awareness. It is sometimes referred to as an acute confusional state, and is extremely common in patients admitted to critical care, affecting 2 in 3 patients.

It is caused by a combination of lack of oxygen to the brain, infections and certain medicines. One of the important things to remember is that delirium tends to get better as the patient’s clinical condition improves, although some patients may have some ongoing problems with memory.

A patient who is delirious can become agitated or be very quiet and withdrawn from their surroundings. It can be distressing to see a relative when they are delirious as they may seem different to normal, and may appear to be seeing or hearing things that are not there. It is unlikely that the patient will have detailed memory of these episodes, although there may be some persistent memories or thoughts.

In the short term, the critical care team are very skilled in recognising and managing delirium. Most of the treatment of delirium involves simple things like speaking to the patient in a calm and reassuring way, telling them where they are, what day it is and what is happening, as well as making the environment as normal as possible by trying to ensure a natural day/night light cycle, and minimising noise.

If a patient’s delirium becomes more severe, there is a risk of harm from patients pulling at devices like special drips in their neck or groin, which could cause serious bleeding.

In these cases a combination of physical restraint and short acting sedative medicines can be used. These measures are reviewed  continuously and are only used for as long as is needed.

Additionally, all patients who spend time on critical care are followed up by the critical care outreach team once they move back to a more general ward, and one of the purposes of these visits is to identify any troubling thoughts or memories from their critical care stay. Then once a patient leaves hospital, they will be offered an appointment in a critical care follow up clinic, and again one of the purposes is to identify any ongoing issues related to their critical care stay. An experienced clinical psychologist, senior members of the critical care outreach team and a consultant in critical care are available to talk to at this clinic.

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