ICU psychosis, also known as ICU delirium, is a common and serious condition affecting critically ill patients. It represents an acute brain dysfunction that can arise rapidly in the intensive care environment.
Understanding ICU Psychosis
ICU psychosis, a specific form of delirium, is an abrupt and fluctuating disturbance in a person’s mental state within the intensive care setting. It involves issues with attention, awareness, and thinking processes, leading to acute confusion, disorganization, and difficulty focusing.
Manifestations vary: hyperactive (agitation, restlessness, hallucinations, delusions), hypoactive (withdrawal, quietness, increased sleepiness), or mixed. Factors contributing to its development include underlying illness severity, certain medications, sleep disruption, and the ICU’s overwhelming or isolating sensory environment.
Direct Mortality and Indirect Complications
While ICU psychosis rarely causes death directly, it significantly increases the risk of indirect complications leading to mortality. Patients with delirium are two to three times more likely to die than those without it. This elevated risk stems from pathways aggravated by the patient’s altered mental state.
A major concern is the potential for self-harm or interference with medical care. Disoriented or agitated patients might attempt to remove life-sustaining equipment, like breathing tubes or IV lines, leading to instability or injury. Delirium is also a recognized risk factor for unplanned extubation in mechanically ventilated patients.
ICU delirium substantially prolongs a patient’s stay in both the intensive care unit and the hospital. Patients with delirium stay an average of 4.77 days longer in the ICU and 6.67 days longer in the hospital, increasing exposure to hospital-acquired infections and other complications, which raises mortality risk. Furthermore, impaired cognition and coordination can lead to falls and injuries. Delirium also impedes physical rehabilitation and recovery, leaving patients susceptible to further medical issues. Disorientation makes patients less cooperative with medical procedures, delaying appropriate care.
Mitigating Risks and Promoting Recovery
Medical teams use strategies to manage and prevent ICU psychosis, reducing risks and promoting recovery. Non-pharmacological interventions are foundational, including early mobilization and regular reorientation to time, place, and situation. Ensuring proper sleep hygiene by minimizing noise and light at night is also important.
Other non-pharmacological approaches include effective pain management, providing sensory aids (glasses, hearing aids), and encouraging family presence and cognitive stimulation. These multi-component interventions are often more effective in reducing delirium incidence and duration. Pharmacological treatments, such as certain antipsychotics, are used judiciously for severe agitation or hallucinations when non-pharmacological methods are insufficient. However, evidence for routine use of these medications is limited, and some studies suggest they may not improve outcomes or could have adverse effects. Early detection and intervention, often using standardized screening tools, are key to improving outcomes.