The future of intensive care: delirium should no longer be an issue
Abstract In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limi...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-022-04077-y |
| _version_ | 1811224069327028224 |
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| author | Katarzyna Kotfis Irene van Diem-Zaal Shawniqua Williams Roberson Marek Sietnicki Mark van den Boogaard Yahya Shehabi E. Wesley Ely |
| author_facet | Katarzyna Kotfis Irene van Diem-Zaal Shawniqua Williams Roberson Marek Sietnicki Mark van den Boogaard Yahya Shehabi E. Wesley Ely |
| author_sort | Katarzyna Kotfis |
| collection | DOAJ |
| description | Abstract In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A–F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a ‘home-like’ (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care. |
| first_indexed | 2024-04-12T08:43:50Z |
| format | Article |
| id | doaj.art-629713b634e044cfb8fffcbc1989a184 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-12T08:43:50Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-629713b634e044cfb8fffcbc1989a1842022-12-22T03:39:46ZengBMCCritical Care1364-85352022-07-0126111110.1186/s13054-022-04077-yThe future of intensive care: delirium should no longer be an issueKatarzyna Kotfis0Irene van Diem-Zaal1Shawniqua Williams Roberson2Marek Sietnicki3Mark van den Boogaard4Yahya Shehabi5E. Wesley Ely6Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in SzczecinDepartment of Intensive Care, Radboud University Medical Center, Radboud Institute for Health SciencesCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Center for Health Services ResearchDepartment of Architecture, West Pomeranian University of Technology in SzczecinDepartment of Intensive Care, Radboud University Medical Center, Radboud Institute for Health SciencesMonash Health School of Clinical Sciences, Monash UniversityCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Center for Health Services ResearchAbstract In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A–F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a ‘home-like’ (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.https://doi.org/10.1186/s13054-022-04077-yOutcomeIntensive care unitPICSPICS-FICU designArchitecture |
| spellingShingle | Katarzyna Kotfis Irene van Diem-Zaal Shawniqua Williams Roberson Marek Sietnicki Mark van den Boogaard Yahya Shehabi E. Wesley Ely The future of intensive care: delirium should no longer be an issue Critical Care Outcome Intensive care unit PICS PICS-F ICU design Architecture |
| title | The future of intensive care: delirium should no longer be an issue |
| title_full | The future of intensive care: delirium should no longer be an issue |
| title_fullStr | The future of intensive care: delirium should no longer be an issue |
| title_full_unstemmed | The future of intensive care: delirium should no longer be an issue |
| title_short | The future of intensive care: delirium should no longer be an issue |
| title_sort | future of intensive care delirium should no longer be an issue |
| topic | Outcome Intensive care unit PICS PICS-F ICU design Architecture |
| url | https://doi.org/10.1186/s13054-022-04077-y |
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