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Bedside Treatments for ABCDE Protocol

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Delirium occurs frequently in critically ill patients and has been associated with both short-term and long-term consequences. Efforts to decrease delirium prevalence have been directed at identifying and modifying its risk factors. One potentially modifiable risk factor is sleep deprivation. Critically ill patients are known to experience poor sleep quality with severe sleep fragmentation and disruption of sleep architecture. Poor sleep while in the intensive care unit is one of the most common complaints of patients who survive critical illness. The relationship between delirium and sleep deprivation remains controversial. However, studies have demonstrated many similarities between the clinical and physiologic profiles of patients with delirium and sleep deprivation.
This article aims to review the literature, the clinical and neurobiological consequences of sleep deprivation, and the potential relationship between sleep deprivation and delirium in intensive care unit patients. Sleep deprivation may prove to be a modifiable risk factor for the development of delirium with important implications for the acute and long-term outcome of critically ill patients.

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Family members and friends who have been identified by patients as their care partners, together with you and other staff, are integral members of the health care team. These family members and friends provides provide comfort and assistance for patients. As care partners, they can also help you share information, by participating in aspect of care, and by helping make decisions. They can be spokesperson, advocate, and supporter, especially if patients are too sick or too overwhelmed to do this for themselves. They are essential to ensuring quality, safe transition to home and ongoing care and recovery once a patient leaves the hospital. The following suggestions are offered to guide you as you become PARTNERS together.

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Session Objectives:
• Review current evidence related to the hazards of deep sedation and the benefits of a coordinated SAT/SBT approach.
• Describe valid and reliable sedation/agitation assessment tools.
• Provide practical guidance for reliable SAT and SBT performance.
• Discuss facilitators and potential barriers to successful SAT and SBT performance.

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Brain Road Map for Rounds (Script for Interdisciplinary Communication)

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We will break our conversation about preventing Post Intensive Care Syndrome into two parts. This month in Part I, we will focus on steps that the health care team will take to prevent PICS. Next month in Part II, we will focus on preventative steps that loved ones can take.

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We are going to discuss Post Intensive Care Syndrome and Prevention Part II - what loved ones can do to help prevent PICS. It is not uncommon for loved ones to feel overwhelmed when in the intensive care unit. The ICU is a very unfamiliar and scary environment for most people and caring for your critically ill loved one can seem like too much at times. However, the physical presence through voice and touch that a loved one can provide can be as therapeutically beneficial as many of the interventions provided by the medical team.

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The emotional aftermath of critical illness/injury is something that often catches people by surprise but can have a significant impact on daily life. People who have been critically ill/injured often describe difficulty with anxiety, depression, and symptoms of post-traumatic stress disorder such as nightmares, flashbacks, and insomnia.

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Following critical illness, it is not uncommon for one to experience new or worsened physical limitations or difficulties. This can be due to the critical illness/injury itself, prolonged time spent in bed with limited physical activity, or preexisting physical challenges that worsen following hospitalization. Of all of the aspects of Post Intensive Care Syndrome (body, mind, and emotions), the physical changes are the most easily recognized and are therefore more readily addressed.

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Short term memory loss. Word finding difficulty. Trouble concentrating. Difficulty with work or school. These are some of the symptoms that patients with Post Intensive Care Syndrome describe having followed critical illness/injury. These symptoms can vary on the spectrum of severity, but for those who suffer from the cognitive effects of PICS even subtle difficulties can be life changing. Loss of work, poor academic performance, and disrupted personal lives are unfortunately a reality for many people affected by PICS.

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It is a common sight in the intensive care unit. Family members at the bedside, sometimes 24/7. Holding vigil and attentively monitoring each moment of the day for their critically ill/injured loved one. After all, who knows the needs and subtle hints of change of the patient better then close loved ones?

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To recap from our first post in this series, the definition of Post Intensive Care Syndrome (PICS) is new or worsening health problems after a stay in the ICU. These health problems can affect the body, mind, and/or emotions and often present after the patient has been discharged from the hospital. These problems may last anywhere from a few weeks, to months, and in some cases even years. People with PICS often experience a wide array of symptoms.