Delirium During Hospitalization After Cardiac Arrest

Confused, aggressive, and restless… Is this expected?

You may have heard of “ICU delirium,” “ICU mania,” or “sundowning.” This is common in ICU patients. They may become confused, hear or see things that are not there, get agitated, restless, and have trouble sleeping. This can happen in 2 out of 3 patients in the ICU and is more common in those that have required breathing support through a machine. It is important to note that there are multiple things that contribute to this condition such as recent sedating medications, infections, lower oxygen levels, disturbed sleep cycle, severe pain, and withdrawal from alcohol or nicotine.

What does delirium look like?

Delirium can look different on everyone. Your loved one may have trouble focusing, become aggressive, restless, confused, unsure of what day or time it is, unsure of why they are in the hospital, believe that they are somewhere else, and have changes in sleep habits.

For most people, delirium resolves within a few days, but it may persist longer if it is a prolonged hospitalization. People most likely to get delirium are those who have dementia, are advanced in age, have poor eyesight or hearing, have an active infection, or have heart failure. Research shows that patients with delirium might have “dementia-like” thinking problems that can last for months. Delirium is different from dementia.

How will the medical team treat delirium?

ICU delirium will be addressed in multiple ways, as no single medication or intervention will immediately cure it. Clinicians will first try to investigate for a treatable cause of delirium, such as an infection or medications your loved one is taking. When they become confused, clinicians will try to redirect them to the current situation, explain where they are, why they are there, and who they are, in an attempt to minimize associated agitation and restlessness. They will ensure that blood draws and interventions are minimized overnight so that your loved one can sleep and have meaningful rest. The medical team will also ensure that blinds are open during the day and sunlight can enter the room (letting the brain know it is daytime and they should be awake). If these interventions fail, the next step will be to either use restraints or have a sitter with them in the room. 

Restraints will either be placed on wrists and ankles or mittens on hands. When requiring soft restraints, your loved one will have soft straps wrapped around their wrists and/or ankles that will ensure they cannot move extremities in such a manner to put themselves at risk or pull any lines or tubes (ET tube, Foley catheter, arterial or venous lines, etc.). If they are somehow able to undo these strap restraints, the medical team may place soft mittens on their hands, which will prevent them from using their fingers to untie the soft restraints.

If the above measures do not help with delirium, the medical team may also start medications to help with sleep (such as melatonin or quetiapine) so your loved one regains a normal sleep pattern, and with proper rest and time can slowly return to their baseline mental status.

Is there anything I can do to help my loved one if they are experiencing ICU delirium?

There are a few things you can do to help and comfort your loved one if they are experiencing ICU delirium. 

• • Remain calm and keep conversations simple, so that they feel comforted and at ease.
  • When you visit, tell them the day, month, and year, where they are, who they are, and why they are in the hospital.
  • Bring their hearing aids, glasses, or other items they may use to communicate. 
  • Decorate the room with calendars, posters, or family pictures. These familiar items might be reminders of home.
  • Play their favorite show and their favorite music, or read them their favorite book.
  • Have them talk with family and friends regularly.
  • Open blinds during the day to ensure sunlight comes in and turn lights and TV off at night to minimize sleep interruptions.

Sources

Delirium for Patients & Families: https://www.icudelirium.org/patients-and-families/overview

What is ICU Delirium?: https://myhealth.alberta.ca/Alberta/Pages/what-is-icu-delirium.aspx#:~:text=Delirium%20in%20ICU%20Patients&text=%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B,changes%20in%20behavior%2C%20and%20confusion

Thank you to our contributors

Samantha Fernandez & Sachin Agarwal