Q: Night shift nurse informed you that patient has an episode of "Delirium" last night but it is resolved now. On your exam this AM, patient appears grossly intact. Should you be still worried?


Answer:  Yes

It is often under-appreciated that in ICU, delirium tends to fluctuate and any reported incident should be taken seriously. To concern to Critical Care physicians, it has been shown that even if delirium resolves, it may be followed for long time by a "loss of memory and reasoning power", end up meeting criteria for delirium for a very long time.  Disturbingly, findings shows that in ICU cohorts, 10% of patients still have delirium at the time of hospital discharge.



References:

1. Cole, MG; Ciampi, A; Belzile, E; Zhong, L (January 2009). "Persistent delirium in older hospital patients: a systematic review of frequency and prognosis.". Age and ageing 38 (1): 19–26.


2. Jackson, JC; Mitchell, N; Hopkins, RO (July 2009). "Cognitive functioning, mental health, and quality of life in ICU survivors: an overview.". Critical Care Clinics 25 (3): 615–28.