Anxiety and delirium in the intensive care unit

To be in respiratory distress is to be anxious. To be mechanically ventilated is to be grossly uncomfortable at best. To undergo weaning in the presence of possible severe respiratory compromise, again, inevitably is anxiety provoking. Assessment of the contributing causes of agitation is essential if patients are to be managed properly. Personality factors may make different contributions to agitation, and necessitate different management approaches. One patient seeks control and another regresses to dependency more easily. Delirium, a common base for agitation, cannot be reassured away or resolved by anxiolytic agents; its root causes need to be corrected before a favorable outcome will ensue. Effective management takes a sophisticated, multidisciplined team, skilled in the physiologic and psychological management of patients. The purpose of a respiratory intensive care unit is to restore respiratory effort and integrity. The anxious patient has difficulty cooperating with weaning and respiratory toilet. The delirious patient cannot cooperate with anything. Until these agitated behaviors are differentiated and resolved, the patient remains at respiratory risk.