In emergency rooms and intensive care units, patients in a state of delirium present more complications and their hospitable stays tend to be longer. Consequently, this condition must be prevented whenever possible. Two physicians at the University Montreal Hospital Centre (CHUM), Drs Marc-Jacques Dubois and Nicolas Bergeron, in collaboration with Dr Yoanna Skrobik of Maisonneuve-Rosemont hospital, have developed a simple but effective method for recognizing its symptoms quickly. Using their scale, they can assess the patient’s level of awareness and organization, coherence of thinking, and motor activity in less than three minutes.

“Delirium is a condition we see quite often in hospitals,” explains Dr Dubois, an intensive care specialist connected with Hôtel-Dieu de Montréal. “I see cases nearly every day. If we can identify it quickly in a patient, we improve his chances of recovering, and even surviving.” Delirium is evidence of suffering that manifests itself as a temporary state of confusion,” adds Dr Bergeron, a clinician in the Medical Psychiatry Department at Hôtel-Dieu de Montréal. “We also see hallucinations, illusions, severe disorientation and agitation.”

Recently dubbed “intensive care unit psychosis,” delirium is often seen in children and the elderly, as well as heavily medicated patients. The word “psychosis”certainly applies here, because the disorder is characterized by a disturbance of cognitive functions.

This syndrome is not immediately fatal, notes Dr Dubois, but it is associated with a high morbidity rate. According to some specialists, when it appears, it is often too late. Whereas in the past the condition was seen as unavoidable among certain patients admitted to intensive care, intensive care staff today believe that it can strike anyone at any time. The condition, which lasts from a few hours to several days, can cause the patient to pull out probes and tubes that bother him. If the patient is connected to an artificial respirator, it can often be fatal. In intensive care units, 6 to 7 out of every 10 patients are intubated. It was while discussing delirium that Drs Dubois and Bergeron began their collaboration. Together with Dr Skrobik they published articles in the journal Intensive Care Medicine on their detection scale and on delirium risk factors. Among other things, they discovered that opiates (e.g., morphine), tobacco use and high blood pressure were connected with the appearance of the syndrome. Of 216 patients studied in a survey published in 2001, morbidity was significantly higher in those suffering delirium. Pulling out catheters and tubes was the most common problem.

Researchers: Nicolas Bergeron and Marc-Jacques Dubois
Telephone: (514) 890-8132
Email: nbergeron@yahoo.com ; marc-jacques.dubois@umontreal.ca