Clinical signs of ICU syndrome/delirium: an observational study

Some clinical signs of the intensive care unit (ICU) syndrome/delirium are probably known, but there may be additional signs that can be observed during the care of ICU patients. The aim of this study was to investigate and describe the clinical signs of the ICU syndrome in relation to patients' reactions and behaviour following the second day of their stay in an ICU. A total of 31 patients were observed during the weaning process and in the days following extubation. Informal dialogues between the patient and the observer, using parts of the questionnaire 'Organic Brain Syndrome Scale' were also carried out. The data was structured in a chronological order and consists of descriptions of patients' behaviour and reactions, together with events, occurrences and environmental circumstances. It was found that the patients showed a great variety of clinical signs that could be related to the ICU syndrome. Such signs were the quality, ability and divergence of speech; talking, movements, bodily position and facial expressions. Several patients also related unreal experiences only occasionally, while others experienced them during longer periods. The clinical signs did not seem to be separate phenomena but were inter-connected and part of a progression, and, therefore must be seen in the overall context and situation. Longer periods of observation and repeated interaction with patients are necessary in order to be aware of onset and clinical signs of the ICU syndrome.