Background: Delirium occurs in up to 78% of clinical cases and is often not detected by medical personnel early enough. The researcher investigated the incidence and appearance of delirium and its associated symptoms in critically ill patients in intensive care units (ICUs).
Objectives:Investigating the incidence of delirium and its associated symptoms in an ICT unit in Southern Taiwan.
Methods:Participant recruitment was between 18 September and 13 October 2016. Criteria included: (1) being a ICU patient aged at least 20; (2) understanding spoken Mandarin or Taiwanese; (3) having no cognition-related medical history such as change in the mental state, brain tumor, dementia, schizophrenia, alcohol and substance abuse prior to ICU admission; and, (4) having a clear mind with no disorientation disorder upon ICU admission. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used as the tool for assessing delirium. The CAM-ICU was used at ICU admission and a reassessment was performed every 24 hours until the assessment scores became positive.
Results: Delirium occurred in 24 out of 89 patients, an incidence rate of 26.9%. The highest rate, which was 36%, occurred on the third day after ICU admission. Delirium occurred on average on the 2.89th day and mostly between 7:00 pm and 2:00 am, amounting to 41.7 %. Delirium-associated symptoms, disorientation and meaningless responses or repetition of a specific behaviour had the highest percentage each of 47%, followed by inability to co-operate with medical measures at 36%, poorer concentration, perplexity or sleep disorders at 18% each, clinical manifestations including incoherent speech, heightened excitability and illusion or incoherence and changes in reflex responses at 9% each.
Conclusions: It is simpler and easier to prevent delirium than to treat an excited, delirious critically ill patient. Hospital admission, subject to routine monitoring, should include assessment for delirium, as well as close follow-up and observation for delirium-associated symptoms and vigilance amid delirium. Early detection and identification can prevent further damage.