Outcomes after Intensive Care Delirium

Dr. Ilkka Kalli, MD, PhD, MBA Editor-in-chief, Clinical Window Web Journal See the editor-in-chief working and his Curriculum Vitae

Dear readers,

The sixth year of Clinical Window Web Journal (CWWJ) starts with our new 21st issue. Its topic is Outcomes after ICU Delirium. We touch base with this clinically important subject, reflecting on the Clinical Window scientific symposium which was organized as part of the ESICM scientific congress in Amsterdam last September. We were celebrating the fifth birthday of CWWJ with a scientific focus on ICU sedation, brain monitoring, and cognitive impairment after critical care. In this issue, we concentrate on ICU delirium.

Current publications

I am delighted to publish very interesting contributions from the ICU Delirium and Cognitive Impairment Study Group from Vanderbilt University. Their multidisciplinary scientific approach, which combines psychology and medicine, deserves special mention. The two-part leading paper by Dr. Wes Ely MD (Vanderbilt University, Nashville, TN, USA) has the general title: "The Delirium Dilemma - Advances in Thinking about Diagnosis, Management, and Importance of ICU Delirium".

In his first article, "Impact of Brain Dysfunction on Intensive Care", Dr Ely points out that ICU patients who experience delirium are exhibiting an under-recognized form of "organ dysfunction". He continues to state that delirium is extremely common in ICU patients due to factors such as co-morbidity, critical illness, and iatrogenesis. Thereafter, he touches on the pathophysiology and etiology of delirium, continuing with its prevalence and ICU-typical subtypes. As the prognostic significance of delirium is great, there can also be significant cost consequences.

Dr Ely continues with a second article: "Strategies for Optimal Management of ICU Delirium". He introduces us to the risk factors for delirium, and emphasizes the importance of combining sedation and delirium assessments at the bedside. Strategies for optimal management of ICU delirium include both primary prevention and various non-pharmacological approaches. Means to optimize pharmacological therapy in the ICU are of particular importance. Gradually, awareness of the importance of this situation has been increasing, but further research is needed to optimize care to prevent underlying causes of the symptoms of delirium.

Dr. James C. Jackson, PsyD (Vanderbilt University, Nashville, TN, USA) gives us a neuropsychologist's overview on "Delirium and Long-Term Cognitive Impairment". According to Dr. Jackson, delirium is a neurobehavioral syndrome characterized by acute confusion, inattention, disorganized thinking, and a fluctuating course. It can significantly prolong hospital stay, and result in adverse outcomes post-discharge. Current theories to explain the association between delirium and negative cognitive outcomes are explained. Additional research on the long-term delirium-related effects on cognitive function is needed, as delirium appears to be significantly implicated in the development of cognitive impairment in large numbers of ICU survivors, as well as in other medical patients.

Clinical Window scientific symposia

Our Amsterdam ESICM symposium was a real success, as we had a packed room of over 220 participants! Have a look at our Amsterdam symposium program at CWWJ in the podium area. We plan to make the symposium a tradition for the future, as we will organize scientific symposia at frequent intervals. In March 2006, come to our lunchtime symposium on respiratory monitoring and spirodynamics at ISICEM in Brussels. Hope to see many of you there, as I would be delighted to receive input from our many readers. At the eve of its sixth year, Clinical Window wants to envision the future. I greatly appreciate your opinions.

Thank you in advance!
Ilkka S. Kalli, MD, PhD, MBA
Anesthesiologist, Editor-in-Chief
Clinical Window Web Journal

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Last updated: 31 January 2006
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