How ICU caregivers are treating delirium in the age of COVID-19

Receiving care in the intensive care unit is a physically and mentally taxing experience, particularly for patients who develop delirium, a psychotic reaction or intense confusion, and the usual methods to combat the condition may not be possible during the coronavirus pandemic, according to an article in The Atlantic.

Patients in the ICU are often receiving care for complex and potentially life-threatening conditions. They often experience both sensory deprivation, from being heavily sedated and isolated, and sensory overload, from intense pain and extended ventilator use.

Remaining in these conditions day after day can result in delirium, which manifests in different ways, ICU physicians and nurses told The Atlantic. Patients may think their organs are being harvested or that they are being tortured.

There are tried and tested methods for helping patients who develop delirium, including limiting sedation when possible and encouraging visitors. But the current pandemic is not only creating the perfect conditions for ICU delirium to arise, it's limiting the methods used to treat it.

COVID-19 patients with severe cases of the illness are often admitted to the ICU and need to be put on ventilators, usually for at least twice the normal amount of time ICU lung patients are placed on the breathing machines. But the tested methods to combat delirium may not possible for COVID-19 patients. For example, it is not possible to allow more visitors for these patients because they are highly infectious. And physicians in their personal protective equipment may further scare and confuse these patients.

But ICU caregivers for COVID-19 patients are finding their own workarounds. Some are organizing video chats for their ICU patients with loved ones, while others are putting photos of themselves on their protective gear, so that patients can see the face behind their care.

"We're figuring out, 'how can we make patients feel less alone when you can't even smile at them?'" Sharon O'Donoghue, a Boston-based nurse told The Atlantic. "You identify what makes a person unique and use that to reach them. And you can see them, for a few seconds, be them."


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