How hospitals can prevent dementia in ICU patients

A checklist that focuses on pain assessment and exercise can help reduce intensive care unit patients' risk of developing long-term mental effects, such as dementia and confusion, NPR reports.

Four things to know:

1. Following the checklist can cut a patient's risk of mental impairment after an ICU stay by 25 percent to 30 percent, said Eugene Wesley Ely, MD, professor of medicine at Vanderbilt University School of Medicine in Nashville, Tenn. This post-ICU condition is different than memory problems that may arise after heart surgery and general anesthesia in the elderly.

"I think the most modifiable piece of this is what we do to the patient," Dr. Ely said. "And what we do to the patient [that] is dangerous is immobilize them chemically [with drugs] and physically, and then not allow the family there, and allow them to subsist in delirium."

2. When Dr. Ely started practicing in the ICU, he realized each physician made different choices about basic matters, such as how quickly to get a patient off the breathing machine, and he thought those small decisions may significantly affect the patient's recovery. To address this issue, Dr. Ely developed an evidence-based checklist of best practices for handling tasks that help patients get back on their feet most quickly.

3. Dr. Ely and other researchers started by creating a system to find when it was safe to take a patient off a ventilator. Next, Dr. Ely said, "we started standardizing how to remove people off of sedation. Then we came up with a way to measure whether your brain was delirious or not."

Other checklist elements include assessing pain, managing medications, testing patients' ability to awaken spontaneously, early mobility and exercise, and having family members present in the room.

4. Dr. Ely's goal is to make the practice a standard at hospitals worldwide. The bundle also could help reduce the cost of care by reducing the amount of time people spend in the costly ICU.  

"But the most important thing, of course, is not the money, it's the human being," Dr. Ely said. "So if they're getting better care, surviving more — often with a more intact brain — and not bouncing back to the ICU ... to me that's a win-win."

More articles on clinical leadership and infection control:
'Eyeballing' patients may find sickest ones more effectively than formal assessment
Sunlight can kill infection-causing bacteria indoors, study finds
Breastfeeding linked to less antibiotic-resistant bacteria in infants, study finds

 

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