WHAT ARE THE MEDICOLEGAL CHALLENGES POSED BY DELIRIUM IN AN ICU?

By Dr Martin Stotz, consultant in adult intensive care and anaesthesia

[DELIRIUM IS A FORM of acute brain dysfunction – defined by acute disturbances in attention, awareness or cognition – that develops over hours or days and cannot be explained by an alternative diagnosis or comatose state. Patients who develop delirium are at an increased risk of complications, and the condition is also associated with longer hospital stays and increased healthcare costs.

Furthermore, delirium is a major risk factor for cognitive impairment following critical illness, which can be particularly debilitating, and the severity of the impairment is related to the severity of the delirium. Over half of all patients admitted to an intensive care unit (ICU) will develop delirium at some point during hospitalisation and in patients who are mechanically ventilated that proportion rises to around 75%. Known risk factors include old age, frailty, preexisting neurologic disease or cognitive impairment and comorbidities such as cardiac disease and hypertension.

or a lack of motivation to follow them due to a belief that doing so will not confer any meaningful benefit to the patient, are also barriers to diagnosis and treatment and should be addressed.