Psychiatric Problems In ICU
Ayman Mohamed Ahmed Abd EL Gawad;
Abstract
Delirium is a Strong, independent predictor of prolonged hospital and ICU stay, reintubation, cost of care, long-term cognitive impairment and mortality
A number of theories have been proposed in an attempt to explain the processes leading to the development of delirium. Most of these theories are complementary, rather than competing. It is likely that none of these theories by themselves explain delirium, but rather it is more likely that two or more of these, if not all, act together to lead to delirium.
Severe sleep disruption is a well-documented problem among critically ill patients staying in an ICU and may impair psychological and physiological well-being.
One of the more frustrating aspects of care of persons with traumatic brain injury is in the management of the agitated patient; agitated patients may resist direct care, be disruptive on the unit, or even pose a physical risk to themselves, family, or staff.
Technological advances during the last decades in intensive care medicine made it possible to treat an increasing number of high risk surgical patients. Nevertheless, many patients awaiting elective surgery experience diffuse anxiety .
Multicomponent interventions have been shown to be cost-effective in preventing delirium when applied to patients at risk of delirium in a hospital setting.
Non-pharmacological treatment must be considered first, common sense and good clinical practice being the rule to avoid light anxiety in ICU patients, for example, reassurance, a comfortable position in the bed, voiding of a full and painful bladder, and so on. Physical restraint can also be considered, keeping in mind the ethical concerns regarding its use.
Although the ideal sedative or analgesic medicine does not exist, optimal features would include the capacity to (1) provide adequate sedation and pain control, (2) provide prompt relief from distress, and (3) allow for rapid recovery after discontinuation (short duration of action with no active metabolites or with an antidote). In addition, the ideal agent would have minimal adverse effects and be relatively inexpensive.
A number of theories have been proposed in an attempt to explain the processes leading to the development of delirium. Most of these theories are complementary, rather than competing. It is likely that none of these theories by themselves explain delirium, but rather it is more likely that two or more of these, if not all, act together to lead to delirium.
Severe sleep disruption is a well-documented problem among critically ill patients staying in an ICU and may impair psychological and physiological well-being.
One of the more frustrating aspects of care of persons with traumatic brain injury is in the management of the agitated patient; agitated patients may resist direct care, be disruptive on the unit, or even pose a physical risk to themselves, family, or staff.
Technological advances during the last decades in intensive care medicine made it possible to treat an increasing number of high risk surgical patients. Nevertheless, many patients awaiting elective surgery experience diffuse anxiety .
Multicomponent interventions have been shown to be cost-effective in preventing delirium when applied to patients at risk of delirium in a hospital setting.
Non-pharmacological treatment must be considered first, common sense and good clinical practice being the rule to avoid light anxiety in ICU patients, for example, reassurance, a comfortable position in the bed, voiding of a full and painful bladder, and so on. Physical restraint can also be considered, keeping in mind the ethical concerns regarding its use.
Although the ideal sedative or analgesic medicine does not exist, optimal features would include the capacity to (1) provide adequate sedation and pain control, (2) provide prompt relief from distress, and (3) allow for rapid recovery after discontinuation (short duration of action with no active metabolites or with an antidote). In addition, the ideal agent would have minimal adverse effects and be relatively inexpensive.
Other data
| Title | Psychiatric Problems In ICU | Other Titles | الإضطرابات النفسية فى وحدة الرعاية المركزة | Authors | Ayman Mohamed Ahmed Abd EL Gawad | Issue Date | 2014 |
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