If you are one of the 5.7 million Americans who ends up in the intensive care unit every year, you are at high risk of developing long-term mental effects like dementia and confusion. These mental problems can be as pronounced as those experienced by people with Alzheimer's disease or a traumatic brain injury and many patients never fully recover.
But research shows you are less likely to suffer those effects if the doctors and nurses follow a procedure that's gaining ground in ICUs nationwide.
The steps are part of a bundle of actions aimed at reducing delirium in ICU patients. Doctors define delirium as a temporary state of mental confusion characterized by a lack of focus, difficulty in understanding what's going on around you and, sometimes, hallucinations.
Risk Of Mental Impairment
Following this checklist of actions can reduce the risk of mental impairment following an ICU stay by 25 to 30%. It is not simply detailed medical care – it's a philosophy. "I think the most modifiable piece of this is what we do to the patient.
Delirium In ICU
And what we do to the patient [that] is dangerous is immobilize them chemically [with drugs] and physically, and then allow the family there, and allow them to subsist in delirium. When I started in the ICU years ago, I have realized every doctor made different decisions about basic matters such as how to quickly get a patient off the breathing machine.
I have figured those small decisions might have a big impact on the patient's recovery. So I've gradually built up an evidence-based checklist of the best way to handle the basic tasks that most quickly get patients back on their feet.
An enormous amount of medical care went into O'Burke's recovery. Overlaid on that was the bundle of steps to reduce delirium. Those are now bakedIn the checklists that nurses, respiratory therapists, and doctors use with ICU patient they treat at Vanderbilt.
Ely explains to the couple that this bundle of procedures is a big change from what many ICUs still do, which is to knock out a patient and treat their dysfunctional body, rather than focusing on them holistically.
Gradually, the bundle of techniques for reducing delirium has been adopted at many ICUs in recent years, Ely says, but is still not the standard everywhere. "It needs somebody to coordinate this, who's going to be here every single day. And so Wes [Ely] helped me kind of champion this project, to empower the nurses and respiratory therapists to make sure this happens every day."
Ely's mission now is to make what your hospital does standard around the world. For one thing, the cost of care, he points out, by reducing the amount of time spent on expensive ICU units.
"But the most important thing, of course, is not the money, it's the human being," he says. "So if they're getting better care, surviving more – often with a more intact brain – and not bouncing back to the ICU … to me that's a win-win."