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Question: My father was recently in a hospital to have a heart operation. During his recovery in the Intensive Care Unit, his behavior was very strange. He seemed confused and agitated and he was even rude to my mother. My father is usually a kind and gentle man. He wasn’t acting like himself. The hospital staff said he was suffering from delirium. What is delirium and how common is it?
Answer: Delirium is very common especially for patients in a hospital’s Intensive Care Unit. Although the ICU provides special one-on-one care for patients in critical condition, the busy nature of these medical environments can sometimes contribute to the development of delirium.
As you likely observed, each patient is watched over by a nurse usually stationed at the foot of the bed. The patients are hooked up to monitoring equipment and life-support machines that often sound alarms. They also undergo frequent poking and prodding for round-the-clock medical tests.
All this commotion can prevent patients from getting adequate sleep. To further complicate matters, they are usually on heavy-duty pain medications and other sedating drugs that add to their mental fog.
And, most important, they are not well – or they wouldn’t be in the ICU in the first place.
These factors, all combined, create a kind of perfect storm that can lead to this distressing mental state.
“Delirium is very frightening for families. Your relative, who previously seemed to be totally normal, is now out of it,” says Dr. Andre Amaral, a critical-care physician at Sunnybrook Health Sciences Centre.
“It happens to about 50 per cent of our patients” in the ICU, he says, adding that the degree of delirium varies greatly from one person to the next.
Some patients experience only mild confusion or become quiet and withdrawn. Others may not be able to recognize their doctor, nurse or even their own family members and can react in a paranoid fashion.
In the worst cases, they could try to pull out their intravenous (IV) lines, pose a danger to themselves, and may need to be sedated with additional medication.
This state of confusion can fluctuate over the course of a single day. You might have noticed this pattern with your father. He may have seemed fine when you visited him in the morning. By the time you returned in the evening, he may have become very restless and agitated.
Doctors readily acknowledge they still have much to learn about what’s actually happening to the brain in these circumstances. But delirium seems to be part of overall organ dysfunction in patients who are very sick.
The chances of developing the condition increase in those who are suffering from multiple medical problems such as heart, lung and kidney failure.
“When you become critically ill, all the organ systems of your body are going through a partial shut down and the brain does the same thing. Because the brain is so complicated we don’t fully understand it,” says Dr. Brian Cuthbertson, chief of Sunnybrook’s department of critical-care medicine.
Heart patients like your father may be especially vulnerable to developing delirium. “If you have blood vessel problems around your heart you probably have similar problems in your brain,” said Dr. Shelly Dev, a Sunnybrook critical-care physician. In other words, restricted blood flow to the brain could further tax mental functions.
Even patients who are less critically ill may experience various forms of delirium. Think back to times when you’ve had a high fever. You might have felt like you were in some kind of trance.
So it’s important to keep in mind that some patients who are actually doing well in their recovery can also become delirious, says Dr. Amaral. And it is not necessarily a sign your loved one has taken a turn for the worse. In these cases, “I like to say it is a little bump on the way,” adds Dr. Amaral.
How much of this experience will patients remember after they’ve left the ICU?
“It’s hard to predict for an individual patient what they are going to remember and how unpleasant those memories are going to be,” says Dr. Dominique Piquette, another Sunnybrook critical-care physician.
“Some people recall bits of it, which are not always pleasant memories. And it is all a bit blurred,” adds Dr. Piquette. “Others have a complete blackout and don’t remember anything … which can be distressing to have lost a chunk of their lives.”
Dr. Amaral says “some people have symptoms of anxiety, stress and depression once they come out of the ICU.”
However, the good news is that family members can sometimes be extremely helpful in comforting delirious patients, says Dr. Dev.
The ICU can be an alienating place, filled with unfamiliar sights and sounds. So, hearing the voice of a loved one can be re-assuring. “I tell the families they are instrumental to healing the patient,” she says.
When patients stir to consciousness, they may not be aware they are in a hospital. “There are not many windows [in the ICU]. There is a lot of noise and a lot of things happening,“ explains Dr. Dev. “You wake up with a tube in your throat, or someone is suctioning [fluid build-up in] your lungs. It can be terrifying.”
Part of the healing involves “reorienting” the patients so they find their way out of the mental abyss. Dr. Dev provides families with the following tips for aiding the recovery process:
- “Ask them their name, where do they think they are, do they remember what’s happened. And, if they get frustrated with all the questions, remind them who you are and why they are in the hospital. ”
- Don’t be afraid to tell your loved one the true nature of their medical condition. Some families are reluctant to do so, preferring to shield the patient from more stress and worry. “It’s more frightening not to know what’s going on and have everyone say you’re fine. You start to think you’re crazy because you don’t feel fine,” says Dr. Dev.
- Help them get out of bed and walk around if, of course, they are capable of mobility. “It makes them feel more normal and less confined.”
- Bring photographs from home and have other friends and family visit if the patient is in the ICU for a long time.
- For patients who normally wear eyeglasses, or require hearing aids, make sure these items are readily available. When they can’t see or hear properly, or there is a language barrier, they face a greater risk of feeling lost and confused.
- Even having something as simple as a clock nearby enables patients to know the time and improves their grasp on the world around them
Many things can be done to minimize delirium or shorten its duration – and some of them involve family members playing active roles in helping to reorient the patient.
However, there are times when it’s not appropriate for relatives to be at the bedside – such as when hospital staff must perform certain procedures. After all, an extended family can include a wide range of relatives, notes Dr. Cuthbertson. “If you’re doing intimate washing and caring then you don’t necessarily want an uncle, or an auntie, or a child being there.”
At Sunnybrook, family members are permitted to visit ICU patients at any time of day, although they may be asked to step outside as medical circumstances dictate.
ICU visiting hours vary from one hospital to the next. If your relative is in a hospital like Sunnybrook, with an open-door policy, try to be there during morning rounds.
This is when the medical team visits all the patients in the ward, assesses them individually and puts together a daily treatment plan. The rounds provide an opportunity for you to see the physicians who have the most up-to-date information about your relative’s condition.
Keep in mind the doctors must visit numerous patients during rounds so their time is limited. If you have lots of questions, use this opportunity to make an appointment with the physician who is most responsible for your relative’s care. At that later meeting, the doctor should be able to answer your questions, including those dealing with topics like delirium.
As a general rule, the patient’s confusion and agitation will lessen as the overall medical condition becomes less critical.
“The vast majority of people will improve significantly over a period of a few days or a week as they get better,” explains Dr. Cuthbertson.
Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. His blog Personal Health Navigator is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Email your questions to AskPaul@sunnybrook.ca and follow Paul on Twitter @epaultaylor
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My husband in ICU is going through this and I believe seeing and hearing my voice would help. But I’m being denied contact with my husband because of Covid and that’s not acceptable to me!! I’m angry and concerned! Family is a huge part of recovery and being isolated is not healing at all! He doesn’t have Covid thats not why he’s there it a different health reason!
My ex husband was on the 3rd week of an alcohol binge when he fell and broke his hip. In the hospital, the combination of alcohol withdrawal with pain medication caused him to hallucinate and say strange things like he had figured out a way to get a car out of the garage when another car blocked the driveway. I am not saying alcohol was involved in your father’s case but probably happens fairly often seeing that someone on a bender certainly doesn’t plan on ending up in a hospital going cold turkey and I would think that the tendency towards serious accidents is more likely when alcohol impaired.
My ex husband was on the 3rd week of an alcohol binge when he fell and broke his hip. In the hospital, the combination of alcohol withdrawal with pain medication caused him to hallucinate and say strange things like he had figured out a way to get a car out of the garage when another car blocked the driveway. I am not saying alcohol was involved in your father’s case but probably happens fairly often seeing that someone on a bender certainly doesn’t plan on ending up in a hospital going cold turkey and I would think that the tendency towards serious accidents is more likely when alcohol impaired.
My friend is in this condition for 8 days now. Kidney is injured as result now and it is very scary. I feel helpless
My friend is in this condition for 8 days now. Kidney is injured as result now and it is very scary. I feel helpless
thank you for this – it helps as my husband is suffering now after a huge heart attack.
I would like to know how you would recommend helping our family members during this COVID-19 mess?? My husband is in the ICU and has been there since June 1st, he had fallen off a ladder at work. Because of the whole COVID-19 situation they are not allowing any visitors at all and they have 1 I Pad for the whole ICU unit for families to face time with their loved ones. My husband is in and out of sedation, some days he seems to recognize me, other days it doesn’t seem that way. He asked me why he was in the hospital and did not remember what had happened. So, if you would be so kind please give me some ideas on how to help him during this time of not being able to be there physically with him and only thru face time. Thank you!
Yeah would be Great to be with my Husband right now he is at UAB and had paratesis 3 times ..he said he feels sick not feeling good .and i cant be there because of this covid19 scare …but he doesnt have it and i dont have it so tell me again why i cant see my husband ?
My Husband was sedated and never came round,I should never have given consent.We never got to say goodbye after 60 yrs together.I will regret it for the rest of my life.I was told it was just to calm him down,not to finish his life.and i truly believe thats what they did.Dont do the same as i did ,think very carefully before you agree to anything you are told
As a friend of a friend who’s mother was experiencing this, I too, think she should have been prepared for this potentiality as my friend was very distraught and calling me for support which I was incapable of providing not knowing about this either! Two people, she and I, were desperately trying to think about the endless possibilities of what could happen as her mother seemed to be losing it and that was so unnecessary because my friend could have been prepared in the first place! My friend was extremely worried and afraid and I had no answers, and only fears myself! This experience was so unnecessary!
My father is in CCU and he is going through the same and thankfully the Nurses and Doctors informed me about this . I was bit worried. After reading the article I am much aware about it now.
Thanks.
Good article. My husband just got home from rehab after being in ICU a total of 3 weeks, moved several times to rehab or back to hospital.For 2 months, he was in the hospital or rehab. He become more confused with each move. What I saw was that medical staff did not note this as a major concern and what the end outcome might be. So he is still confused 2 months later. We currently have home health, therapies. He is very slowly getting better but it will be a long process. Not sure of what the outcome will be.
Hi Deborah… did your husband ever come out of it?
My husband was admitted for dangerously low oxygen, flu , pneumonia & lung infection. Was sedated for 3 weeks & now still in hospital as he’s still very confused & doesn’t make sense most of the time, he was given antibiotics for a viral infection they suspected in his brain & it seems to have worked to a degree . We are still waiting for lumber puncture results & I’m so scared he’s not going to come out of it!
How is he now? My mother in last currently in that state. Sleeping but not arousAnle for 2 full days now. All the other things above mentioned are the same .
Can I ask if he came out of it? Thank you
I was delirious in the past for a few months and then came out of it. I can remember a few things I seen like a baby falling off a file cabinet but never actually fell and things on the walls. Anyway a few months ago a Dr. said that I was partially delirious again but how could that be if I know what was going on for the most part? I was confused but remember a lot. Thanks for your time Jessica
I don’t know how to feel after reading all the comments. My mother just got out of ICU on Friday,and now she is home with me. She is still going on about how people are after her and her family, how they are talking about her and planning her demise. I’m at wits end and have no idea what to do. The doctors didn’t warn me, and when i enquired about it when i went to fetch her yesterday they just said it happens, just like that,no tips on how to deal with it or how to handle the situation. I’m losing my mind here. I don’t know whether to tell her that it was all her imagination, or just let it slide and hope she will forget or come to her senses. It breaks my heart seeing her like this
I have A brother who has been in the hospital a month. He had neck surgery but never recouped.He was diagnosed with I.C.U. Delerium. He shows all the signs of it but doesn’t show many signs of getting better is there anything my family can do that will help give him some comfort. Most of the time he is terrified and out of his head. I see no signs of him getting better. He can’t even eat on his own.
I can absolutely relate to the anger expressed by commenters here because I feel it too — and I was an ICU patient. Not only did my hospital fail to tell my family what to expect as a result of my intubation and delirium — to say nothing of my near-fatal medical conditions and heavy drug treatment — but they didn’t provide any information about the possible after-effects of being in the ICU. And that’s both bad medicine and incredibly cruel. Look up “Post ICU Syndrome.” It’s well known within the medical community that being in the ICU is only the start of what can be many, many months of difficult recovery. It’s recovery that can have serious mental and emotional aspects. My hospital and doctors discharged me without telling me anything about this. And as I learned later, this wasn’t an oversight. It was intentional and I suffered. I’m very distrustful of the medical establishment now.
You sound like me I think of what happened to me in icu every day it’s been over a year I’ve had to turn to the internet to find out what happened time in there . The nurses were so mean to me. I had a double lung transplant. After the tube went in and out a few times it scratched my throat I couldn’t talk well the Drs said you know you can talk now and walk away. I started writing stuff down nurses were doing or not doing to me. They were so angry treating me even worse. I had no way to communicate unless someone took the time to listen to me. Closely I asked for the chaplain. I was sure they would listen but I looked over and the nurses were chatting with the chaplain. She turned and walked away. They didn’t want me in icu so put me on the ward I wasn’t well with severe diarrhea and had tocall a nurse for help constantly. Eventually i buzzed the nurses she knew I was going down I heard her calling for help then nothing. She came running back with the guy with the cart I guess I dropped went into respiratory failure. They got me breathing again and my nurse had to beg icu to take me back they then put me out for three days. Omg soma you scary experiences the list goes on but I was so helpless. My worst fear is me not being allowed to have another transplant because of how I was in icu. Ione of the cordinators told me after transplant toget my mental health checked like this was my fault and there was something wrong with me. I’m still sitting on it all im afraid whoto talk to about all this. They turned away my three children and I had no one there for me exactly what they wanted I couldn’t see very well due to the drugs to reach out to get help from someone. It’s horrible I never want to go through that again!!! But I’ll stop here . I see a psychologist soon it’s risky talking to him because he works for transplant. Any advice would be great !!
I am very concerned that none of the articles have sources cited.
Im currently going through this with my Grandmother. We should have been warned if it was so common. Our hearts are broken and don’t wish this on anyone!
My sister just went through this very thing. Her children and my other sister and myself were terrified. I agree that family should be warned that this is a possibilty before it happens and not the day after when it was mentioned to us.
My mother is in ICU for pneumonia, plus she has kidney failure which she receives dialysis.From one day to the next she totally lost all touch with reality.She became mean and swearing, she tried to rip an IV out of her arm.She thought all of her family were in on a conspiracy to kill her because we want her money.She was saying she hated us, we make her sick, that we hate her.It was awful.Will she come back from all this once the infection is gone, they said it is clearing up but I see no improvement.She won’t eat or drink because she thinks there is poison in in.Even the staff there she thinks is out to kill her.
My son was on ventilator for ten days and when he got the tube out the next day he started saying I was trying to kill him and I paid everyone in hospital to kill him. The next day was even worse cuz he thought I had a sniper outside trying to shoot him and I was only there to finish the job myself since they didn’t do it yet. I finally had to leave because he was getting so upset. I have stayed away for two days now and I’m sure hoping that he will be different tomorrow. It’s been so hard.
Be patient I’m sure it’s hard to hear and see your family member like this. Just love her talk to her tell her what is real and not real. I’ve been here !!
i was exactly the same. It
Hi just reading your comments. Did it get better for your mom?
Thank you
My sister is in ICU and she is experiencing this it’s hard to understand what’s going on with her some days she is normal and than she goes back with not knowing
Thanks for this information
Mary G
How long does it last when patients have delirium?
I had it 2 for 2 weeks after spending 2 months in a coma with sepsis. Its a gradural thing.
Only a week after getting out isn’t bad. How long can it longer?
Todd Charske!
Linger. Not longer
I would like to know if it happens 50% of the time to Patients Then why the hell aren’t the Families at least pre-warned about it?? This is so messed up for people !! Secrets are not usually the best way to deal with any situation let a lone when someone you love is fighting for their life!! I feel it is a very bad display of bed side manners and this is just UN-Except-able.
Yes I agree relations of the patients haven’t aclue what is going on with their loved one in Icu.
I couldn’t agree more with you, especially when you have nurses telling you all sorts of things aswell,….but ABSOLUTELY why on earth aren’t we prepared for this ???!!!???….as you say….inexcusable, & very frightening for family all round .
They put him on o medicine to reverse the effects
Can this cause the psychosis to get worse?
I had the same frightening experience with my partner, who did not come completely out of the psychosis until two weeks after release. Nobody warned us it might happen, or prepared us with any type of medication. The patient and family suffer needlessly, because of lack of information and aftercare. A real travesty and quite negligent of the medical system.
I agree Valerie, the same thing happened to my dad and I was so shocked and confused myself. If we had been prewarned this could happen we would have been expecting it and know how to handle it to make it less stressful for out loved one and ourselves. I only found out what it was via internet. Crazy right?