Rousing ICU Patients Shows Benefits

The most seriously ill hospital patients reside in the intensive care unit (ICU), a necessary treatment that nevertheless presents serious risks of its own. (See our blog, “Brain Problems Can Endure Long After Leaving the ICU.”) Recent research shows that waking up ICU patients and encouraging them to breathe on their own decreases both their sedation levels and how long they remain in a coma.

The study, published in the journal Critical Care Medicine, also indicated that these practices reduced the delirium that critically injured people often experience.

The study subjects were 702 ICU patients at least 18 years old. The researchers made no other changes to ICU staffing practices other than those tested in what they called the Wake Up and Breathe program.

As described in a news release issued by Indiana University, one of the participating institutions, patients who are on ventilators (to assist breathing) typically receive both sedatives and painkillers. Excessive sedation can extend the time the patient stays on the ventilator. The longer someone stays in the ICU, the more likely he or she experiences delirium, a state of serious confusion and an inability to focus.

But too little sedation can leave patients agitated and cause them to be disconnected from the breathing machine before doctors believe they are ready. Excessive pain medication and sedation have been associated with acute brain dysfunction characterized by coma and delirium.

“Being on too high a dose of sedation medications or painkillers isn’t good for the brain, especially the aging brain. Typically about 80 percent of patients in an ICU develop delirium,” said Babar A. Khan, M.D., the pulmonologist and critical care physician who led the study and was quoted in the news release. “In our study … we stopped sedation in the morning and woke patients up to breathe on their own with assistance from an interdisciplinary team of nursing, physicians and respiratory therapists. Only 50% developed delirium, still too high a number, but significantly better than typical.”

Every year, about 5 million Americans are admitted to a medical or surgical ICU, and slightly more than 1 in 3 of these critically ill patients receive mechanical ventilation because they are comatose, have lung disease, pneumonia or sepsis (severe, systemic inflammatory response to infection) or for other reasons can’t maintain an open airway.

Delirium generally prolongs a hospital stay and carries a risk of developing dementia. Obviously, it’s in a patient’s interest to do everything possible to avoid it.

And, according to Khan, “In addition to increasing the probability of long-term cognitive impairment, we know that assisted breathing over a period of time is bad for the body as it increases muscle atrophy, resulting in physical function problems later.”

If your loved one is an ICU patient, make sure the staff knows you’re familiar with the adverse effects this treatment can have. Ask how much sedation the patient is being given, if it’s the lowest dose possible and when the doctors plan to reduce or eliminate it. Discuss options for minimizing the chances of delirium, and what measures are being taken to encourage the patient to breathe without the ventilator.

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