E. Wesley Ely, MD, MPH
Every day, 30,000 to 40,000 ICU patients in the United States are suffering from acute brain dysfunction called delirium. This problem is getting larger every year due to the aging of our population. Traditionally, this is called "ICU Psychosis," and professionals have not thought it to be clinically significant. Using clinical tools designed and validated at Vanderbilt University, Dr. Ely and his ICU Cognitive Impairment study group has shown that delirium is associated with a tripling of the risk of death within 6 months of ICU, millions in dollars of associated cost, and a ten-fold risk of ongoing cognitive impairment following survival. Even considering other factors such as age, severity of illness, duration of coma, and the use of psychoactive medications, every day spent in delirium by ICU patients was associated with a 10% higher risk of death. Thousands of ICUs around the world are now implementing routine monitoring for delirium based on this work, which has been translated into 11 languages, and national guidelines have embraced delirium monitoring for the first time. Ongoing clinical trials organized by Dr. Ely and his colleagues are now exploring the safest and most effective ways to prevent and treat ICU delirium in hopes that such treatment will not only reduce delirium but also the high morbidity and mortality associated with it.