© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org
Advances in patient comfort: awake, delirious, or restrained
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In this editorial, three aspects of comfort of intensive care patients will be explored: avoiding unnecessary coma; delirium; and physical vs pharmacological restraint.
Avoiding unnecessary coma
Most intensive care units (ICUs) in the UK have a significant input from anaesthetists. Anaesthetists are used to rendering patients unconscious, primarily so that they do not suffer during surgery. Critically ill patients are also often kept unconscious and nothing is seen as unusual or wrong with this. There is increasing evidence that unnecessary sedation may increase patient morbidity and costs.1 2
The quantity and quality of staff available influence the amount of sedation given. Natural light and a clock orientate patients while reducing noise from alarms, etc., encourages sleep. Communication problems can cause frustration and agitation, which will be exacerbated by poor hearing, eyesight, or both. The adverse effects of sedatives are widely known,3 yet they are often
Delirium
Identification
Prevention
Treatment
Restraint
Chemical vs physical restraint
Ethical and legal issues
Declaration of interest
1 The John Farman Intensive Care Unit
Addenbrooke's Hospital
Cambridge CB2 2QQ
UK
2 Acute Intensive Care Unit
University Hospital of South Manchester
Southmoor Road
Manchester M23 9LT
UK
* E-mail: gilbertpark@doctors.org.uk