Delirium

Delirium is the brain’s reaction to a serious medical problem. It is common when someone is critically ill and it is estimated that approximately two thirds of patients on a critical care unit will experience delirium at some point during their illness. It is very difficult to pinpoint exactly what causes delirium and it is likely to be a combination of several factors, including:

• Pain
• Certain Illnesses for example Lung Failure
• Fragility
• Sensory Impairment
• Pre existing health conditions
• Dementia
• Being on a ventilator
• Unfamiliar Environment 
• Having Delirium in the past
• Medication for example Sedatives
• Severe Infection

 If you are visiting someone who is experiencing delirium, there are things you can do to help:
• Reassurance. For example, let them know where they are, who you are and that they are safe.
• Talk calmly to them and use short sentences. It may help to read them some of a favourite book or play their favourite music if they are not able to respond.
• Let staff know if the patient wears glasses or hearing aids.
• Bring in familiar objects or photos from home that the person may find comforting.

Staff will also help patients with delirium. For example, they will try to address any medical problems that might be adding to the delirium, get the patient into better routines with sleep and eating / drinking and get the person moving when they are able to do so safely.

Together with family Occupational Therapy staff create ’A little bit about me’ boards for each patient. These boards help facilitate personalised care and help other staff members get to know each patient.

Some people will not remember their time on the unit or what happened to them. Others may have distressing memories about it. The following are common reactions in people who have been critically ill:

• Fear or anxiety: reminders of the experience might lead to anxiety e.g., sounds, sights, smells or reminders on the news or TV. However, anxiety might also feel like it comes ‘out of the blue’.
• Reliving experiences: a person may have unwanted memories, thoughts or images about the delirium. These might be very vivid, so that the person feels like it is happening again (flashbacks), or they might have nightmares
• Emotional changes: common feelings are sadness, anger, fear and guilt. Alternatively, some people feel numb, detached and unable to have positive feelings
• Being ‘jumpy’: being easily startled by things like loud noises or sudden movements
• Difficulty falling or staying asleep, or restless sleep
• Trying to avoid thinking about the experiences they have had or avoiding anything that would remind them of it
• Relationships: difficult experiences can bring people closer, but they can also put a strain on relationships. For example, the person might feel that others don’t appreciate what they have been through, or friends and family may be struggling with their own reactions to their loved one having had delirium
• Coping: some people might turn to alcohol or drugs to cope, which can lead to other difficulties

There is no right way to react after being critically ill and having delirium. Everyone’s reaction will be different, and you may experience all, some, or none of the above reactions.

These are some experiences real patients have shared about having delirium on the Critical Care Unit:

“I thought they were getting ready to take me up there to experiment on me and they were going to kill me. And that was horrible. And my family was coming in and I didn’t tell anyone and that was a horrible feeling…I just kept it to myself…I thought I was going to die.”

“I apparently had a fight with some male nurses. I don’t remember a thing about that, and that’s not me. I apologised profusely on that one because I just can’t believe I did anything like that.”

“I felt like an asylum seeker trying to get into the country because I was on a ferry, hiding on top of a pile of pallets… Someone was saying, ‘She is pulling the tubes out, pulling her tubes out,’ and they were dragging me across the top of the pallet. But you see I wasn’t seeing them as saving me or helping me. I felt I was in an alien place, that’s the word for it.”

Whilst delirium is common on the Critical Care Unit, it may leave patients feeling distressed. If that is the case then there are things that can help with managing distress more effectively:

• Routine: Getting a sense of routine back is important. It might help to draw up an activity schedule for yourself each week to make sure you pace yourself at first and are not trying to do too much. Rest is very important for body and mind during recovery from critical illness

• Look after yourself: Look after yourself by eating well, reducing alcohol use, exercising where possible and getting into a routine for sleeping

• Try not to bottle your feelings up: It can really help to talk about your experiences with someone you trust. If you find it difficult to speak to friends and family, it may be helpful to speak to someone else such as a GP, work colleague, member of a religious group or mental health professional
Some people find it too painful or overwhelming to remember their time in hospital and may need time before being able to speak about it. You may want to try other ways to express your feelings in a way that feels safe for you – some people find exercise, drawing, writing or a creative class helpful, but there are many other ways you could try

• Going over your experiences: It can help to go through what happened in hospital and have a timeline of events. Staff often create ‘patient dairies’ which detail what has happened in hospital, this can help you piece together what happened and what was real or not

• Grounding’ exercises can help at times of intense distress or if you are experiencing flashbacks. These can ground you in the here and now, which may help you to feel less distressed.
- Notice 1 thing you can see around you
- Notice 1 thing you can hear around you
- Notice 1 thing you can feel or touch
- Notice 1 thing you can smell
- Notice 1 thing you can taste
- Take one or two relaxed breaths if you are able to and remind yourself that you are safe now

You might also use relaxation methods, such as breathing exercises. One simple breathing exercise is ‘Rectangle Breathing’.

This works by making the outbreath longer, which can calm the nervous system. Breathe in for the count of 3 and breathe out for a count of 5.

Or imagine breathing around a rectangle. Breathe in through your nose along the short side, and out through your mouth along the long side.

If you find that you are experiencing some or all of the things described above for longer than one month without improvement, you may wish to seek further advice.

Most areas have a psychological wellbeing service which you will be able to access. If you are registered with a GP in England, you can discuss your options with your practice.

The Critical Care Unit at Blackpool Teaching Hospitals also offer an outpatient follow-up clinic. This is available to answer any questions you may have about what happened in critical care and to check on how you are doing from a physical and an emotional perspective. Patients who were on the unit for four or more days are automatically invited. If you haven’t been invited and would like an appointment, then please contact the unit on the telephone number under ‘contact details’ below and they will be happy to arrange this for you

Should you require further advice or information please contact:
Critical Care Unit: 01253 953440
If there is no answer then please leave a message with your name, contact details and reason for calling and someone will get back to you.