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 ICUdelirium.org and Article on Harmful ICU Stays 
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post ICUdelirium.org and Article on Harmful ICU Stays
Many of those in our local support group spend some time in ICUs -- usually due to pneumonia, but sometimes due to other problems (sepsis, for example). In a recent study done of ICU patients by Vanderbilt, it appears that the ICU stay itself can be physically or mentally disabling.

A Wall Street Journal article from last Tuesday is about this problem. The author says: "Intensive-care units have long kept critically ill patients immobilized, heavily sedated and on a breathing machine. The aim is to keep them free of pain, anxiety and agitation as they heal and undergo invasive procedures and monitoring. But there is growing evidence that such care can increase patients' risk for other problems after they leave the hospital and in years to come. Studies show that prolonged heavy sedation, for example, can trigger or exacerbate delirium, a temporary state of acute brain injury that has been linked to higher rates of death and dementia. Patients immobilized in the ICU quickly lose muscle and bone strength and become frail, which can significantly slow the pace and degree of recovery."

The article points to a very useful website developed by Vanderbilt, icudelirium.org. While many of the pages address medical professionals, there are layperson-friendly pages on the website as well. I dug around a bit and recommend these pages in particular:

Quick Facts about Delirium for Patients and Family
http://www.icudelirium.org/patients.html

Delirium Education Brochure (about ICU delirium)
http://www.icudelirium.org/docs/deliriu ... ochure.pdf

Delirium Mnemonics for diagnosing delirium, ICU delirium, and differentiating delirium from dementia
http://www.icudelirium.org/terminology.html

The Vanderbilt website mentions the ABCDEs of delirium prevention and safety. The Wall Street Journal article suggests that the "ABCDEs for the ICU" should be used by families when a loved one is placed in intensive care:


ABCDE's for the ICU

Here are some steps to ask medical staff if they are taking when a loved one is in intensive care.

Awakening
Action: Patients should be woken from sedation at regular intervals.
Consequence: Prolonged sedation can result in delirium, or severe confusion, which in turn is associated with long-term cognitive impairment.

Breathing
Action: Patients should be assessed daily for their ability to breathe without a mechanical ventilator.
Consequence: The use of a ventilator for long periods can boost the risk of pneumonia and lead to longer hospital stays.

Choice of Sedation
Action: Use milder sedative drugs if feasible.
Consequence: Commonly used drugs, like benzodiazepenes, may contribute to brain injury.

Delirium Monitoring and Management
Action: Hospital staff should evaluate patients for delirium routinely, such as by asking them to identify objects in photographs, and should modify treatment accordingly.
Consequence: Patients with delirium run a greater risk of infections, adverse effects of medications and excessive sedation.

Early Mobility
Action: Conscious patients should be gotten up and moving and started on physical therapy
Consequence: Lack of movement contributes to muscle atrophy, bone loss, blood clots and skin ulcers.


Some of you will want to check out the full Wall Street Journal article. Here's the citation and a link:

http://online.wsj.com/article/SB1000142 ... 20948.html

Wall Street Journal
The Informed Patient
Changing Intensive Care to Improve Life Afterward
February 15, 2011
By Laura Landro

Robin


Sat Feb 19, 2011 7:28 pm
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
Thank you, Robin.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Sat Feb 19, 2011 7:45 pm
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Joined: Wed Oct 28, 2009 11:53 am
Posts: 969
Location: Ocala, FL
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
Really good information. Thanks, Robin.

I want to die at home with my dignity.... and my sanity intact. I've made that very clear to my kids.

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Leone Carroll (75); wife of Dale (75) who passed away March 23, 2011


Sat Feb 19, 2011 8:30 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
Too late, Leone! :lol:

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sat Feb 19, 2011 8:44 pm
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Joined: Sun Oct 21, 2007 4:18 pm
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Location: Acton, MA
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
Pat, shame, shame!!!! :P My oncologist has always said avoid hospitals, if you can't, get in and out as fast as possible.

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Gerry 67, cared for Frank 71, married 49 yrs; dx 2004, passed away October 26, 2011.


Sat Feb 19, 2011 8:49 pm
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Joined: Sun Jun 24, 2007 5:35 pm
Posts: 343
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
Thank you, Robin.
What is your background? Are you a nurse? You always have such good research information to share with us.
Pat

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Pat Snyder, husband John, dx LBD 2007
Author of [i]Treasures in the Darkness: Extending Early Stage of LBD...[i][/i] [url]http://www.amazon.com/Treasures-Darkness-Extending-Alzheimers-Parkinsons/dp/1466428228/ref=sr_1_1?ie=UTF8&qid=1334092686&sr=8-1[/url]


Sat Feb 19, 2011 8:50 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
Gerry, your oncologist is right! For so many reasons: Errors, infections, confusion and cost, just to name a few.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sat Feb 19, 2011 8:52 pm
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Joined: Wed Oct 28, 2009 11:53 am
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Location: Ocala, FL
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
Actually, I've been thinking a lot about that recently. If Dale should fall and hurt himself ... requiring medical attention, I really don't want him to be in a hospital .... where he'll probably get pneumonia. There are some 'emergency room' type businesses here now. Will an ambulance take him there instead if I request it? How do we avoid the typical hospital emergency room?

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Leone Carroll (75); wife of Dale (75) who passed away March 23, 2011


Sat Feb 19, 2011 9:00 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
If you're referring to 'urgent care clinics' I don't think an ambulance would take him there. I think they have to take you to the nearest hospital.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sat Feb 19, 2011 9:14 pm
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
Leone, have you looked into any of those alternative ERs? Would they offer advantages over a regular ER, in your situation? I don't know anything about them and I'm curious.

It probably is a good idea to plan ahead in case you can't avoid Er or hospitalization. What are your best options?

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Sat Feb 19, 2011 9:17 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
At any rate, most people going into the ER aren't admitted to the hospital, anyway.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sat Feb 19, 2011 9:41 pm
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
Here's my limited experiences with ambulances & ERs - different ambulance services seem to contract with certain hospitals. If you want to go to a specific ER, you need to find out which ambulance will take you to which hospital, if you live in a place where there are choices.
I have told my family that if I am ever in the town where my dad lived and needed an ER for something really serious, drive me to Annapolis, I do not want to go to the hospital where my mom died needlessly and my dad received pretty awful care until I met with the head of nursing.
However, if I required an ambulance, the only ambulance in town takes you to that one hospital, and will not transport people to any of the hospitals of choice which are each about an hour away.
You may want to check into this in your community before you end up with you or a LO somewhere that is not your top choice (if you have a choice). Lynn

_________________
Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Sat Feb 19, 2011 11:42 pm
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Joined: Fri Dec 31, 2010 3:07 pm
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Location: Minnesota
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
I suppose that it must vary considerably from one community to the next. I have called 911 twice for Coy and once for my mother, and all three times after the ambulance arrived and it was determined the patient needed an ER I was asked which hospital we wanted to use. There may be limits to how far they will go -- I don't know, because my choices were in a fairly close range (though not the nearest). The time Coy was unconscious, I wasn't home, and neighbors called 911 so there was no one to ask, they took him to the regional trauma center. (This was preLewy.)

If you have a choice, it is probably a good idea to think about where to go ahead of time.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Sun Feb 20, 2011 1:41 am
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
Pat -
To answer your question, I'm a layperson like most of the people here. I do a lot of reading, and with 250 people in the local support group, I've got lots of people helping me with reading. Please a few online friends (like DrP) send me things too.
Robin


Sun Feb 20, 2011 1:39 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: ICUdelirium.org and Article on Harmful ICU Stays
Perhaps some of you can start a separate thread on calling an ambulance and ER visits....?


Sun Feb 20, 2011 1:41 pm
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