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Vanderbilt’s Dr. Wes Ely tests a patient for ICU Delirium.

Hospital patients who go home after a stay in intensive care may leave thinking the worst is over, but 60 to 80 percent are likely going home with a new problem – a brain injury.

ICU Patients

A 54-year-old petite and bubbly bookkeeper named Marie Smithers spent six weeks in the ICU at St. Thomas Hospital in Nashville last March. Nine months later, she still suffers from memory lapses and balance problems. Smithers is back at work, but it’s a constant struggle for her to remember simple tasks.

“There’s some things…the forgetting. Going down the basement steps, all of a sudden it’s like, I don’t remember exactly how to do this,” says Smithers.

Marie Smithers still struggles with memory and balance nine months after leaving the hospital.

The Causes

ICU Delirium is triggered by the disease and/or infection that lands patients in the ICU, along with heavy duty drugs meant to keep them comfortable.

Vanderbilt critical care doctor Wes Ely has studied ICU delirium for a decade. As he points to the plastic ventilator tube running into the lungs of ICU patient, Craig Nudds, Dr. Ely says heavy drugs allow the patient to tolerate the tube. But, “We often tend to overshoot,” says Ely.

Dr. Ely estimates 50 percent of the delirium is caused by sedation drugs. He founded what’s now the world’s largest ICU Delirium research group. Its aim is to find the perfect drug cocktail that balances comfort and consciousness to keep the brain from descending into delirium.

Dr. Ely says an ICU patient’s memory, cognition, and executive function diminishes the longer ICU delirium lasts.

Recognizing Delirium

Nudds, who has pancreatitis and lung failure, also has ICU delirium, and Dr. Ely has been tracking the depth of it for a few hours. As Nudds opens his eyes, Dr. Ely picks up his hand and starts squeezing it to see if the patient is conscious enough to respond.

It takes Nudds takes a few seconds to return the squeeze. Dr. Ely says he took too long, and Nudds has a classic case of ICU Delirium. “His brain is just swimming through molasses,” says Ely.

To diagnose ICU delirium, Ely and his team developed a simple two-minute test. It’s a series of questions that doctors pose to patients. If the patient responds correctly, a harder question is asked.

Most ICU’s in Nashville do not test patients for ICU Delirium.

The Long-term Effects

Based on Craig Nudds’ responses, Ely says, at the very least, he’ll end up with memory problems for a few days or it could be worse. He could end up with dementia-like symptoms that mimic Alzheimer’s.

“The longer he stays delirious, the more likely he is to have neuropsychological problems on the back end with memory, and processing speed, and executive function, meaning he would have problems like a dementia,” says Ely.

For decades, patients were told their fogginess and memory lapses were temporary. “It’ll get better after you get home,” was the conventional wisdom.

But Ely’s research shows it can be a life-altering, long-term problem. That’s why he’s pushing for every ICU to start testing for delirium. Right now, among Nashville’s major hospitals, only Vanderbilt screens for the condition.

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