Will the cognitive problems associated with sepsis improve as the infection is treated?

March 5, 2012 8:36 AM

Will the cognitive problems associated with severe sepsis improve as the sepsis itself is treated?

My 74 year old father has apparently survived a bout of severe sepsis and is now in recovery. His kidneys were affected as was his liver and heart (he suffered a mild heart attack) but what has me worried the most is his cognitive functions. He became increasingly confused during his initial treatment phase and began hallucinating. He appears to have responded well to IV antibiotic treatment and his internal organ functions are all beginning to return to normal. His mind, however, seems to have gotten worse. He is still confused and hallucinating but has become less verbal and more agitated. Can anyone offer advice or point me to a website with advice on the mental affects of sepsis and what we can expect in the coming days and weeks? Are his experiences really normal for sepsis or is there something unusual about my father's situation? Will he eventually recover his mental faculties or will there be residual problems for him? Any help would be appreciated.

posted by Jamesonian to health & fitness (9 answers total)

I'm so sorry. I don't have literature to point you to, but I can offer an anecdote from personal experience.

My own father went into septic shock after a mild UTI + kidney stone blocking his urine. (The urologist said he had seen this happen two or three times before, with patients in their 30s -- who died.) He was maybe 70 at the time? He damn near died, and they had to perform otherwise minor surgery while he was basically at death's door, and he was in the ICU for over a week. Dad was confused and out of it the whole time. When he first went into the hospital, the ambulance guys assumed he had Alzheimer's. Later, in the ICU, I guess it was partly the meds -- he was sedated and intubated for a while -- and partly the medical condition itself. He was sort of out of it in a normal hospital room for a couple of days, and increasingly improved when he went home.

Now it's 5 years later, and he's exactly his old self. Well, the experience seemed to age him a bit, cosmetically. But mentally he is 100% back to normal. AND he's back trail running several times a week. He hardly remembers his stay in the hospital.
posted by kestrel251 at 9:05 AM on March 5, 2012 [1 favorite]

My dad had a bad systemic infection a while back and was definitely delirious and confused (the local hospital's intercom code for security is "code gray"!) It improved very rapidly as the infection was treated, and left no lasting effects that I'm aware of. (That bout was ten years ago, so he would have been mid-50s, and frankly he's always been sort of a bumbling goober, so I'm not sure how we'd tell if he was *more* chronically confused than usual, but there doesn't appear to be any medically significant long-term affect.)
posted by restless_nomad at 9:07 AM on March 5, 2012

The name of the condition your father is experiencing is delirium. Here's basic info on it. There's more detailed info, but in pdf form from NICE here.
posted by Coobeastie at 9:40 AM on March 5, 2012

Certainly sounds like delirium. ICU delirium is very common, and especially in older patients (medicines we give, bad sleep schedules, stress on the body). I'd speak with the physician taking care of him or the ICU nurse about your questions and what's being done about it.
posted by gramcracker at 11:09 AM on March 5, 2012

My late father experienced delirium several times, the first time when he had his knee replaced, then later when he got periodic infections while living in a nursing home. He would get very agitated and paranoid and did have hallucinations at least once; I got in the habit of giving the nurses my cell phone number so that they could call me when he got bad and I'd come over and talk him down (I think to a certain extent he just wanted to be heard; I would let him rant, then reassure him that things were okay, and he'd eventually settle down). Each time the infection cleared up, his mind would clear, too.

One thing to keep an eye on is that this could be medication-related. What we found with my father is that the drugs they gave him when he got agitated (Haldol, in particular) had a paradoxical effect and made him MORE agitated. I think it was the pain medication that set him off after his knee was replaced, so they gave him Haldol, which made it worse, then they gave him something else, which made it worse, etc., etc. What we did was to tell the hospitalist (repeatedly) that no more sedatives were to be given, and my sister and I took turns sitting in his room 24 hours a day to keep him calm while he got the drugs out of his system. The hospitalist was pissy about it, but the nurses and aides appreciated the help, and the surgeon told us we did the right thing.

Sorry about the wall of text, but memail me if you have any questions.
posted by WorkingMyWayHome at 11:44 AM on March 5, 2012

Don't despair. Chances are excellent that this will get much, much better very soon. It's very common for people who are very ill to experience delirium while hospitalized, whether from the effects of the illness itself, the scary and unfamiliar surroundings, or side effects of medications (that's a big one). It's so routine that nurses and doctors often tend to brush it off, which is frustrating cause the family's in a state of emotional panic.

The good news is that this sort of delirium commonly goes away completely once the patient is home with their health stabilized. I hope you're both doing much better very soon.
posted by Corvid at 11:57 AM on March 5, 2012

Just chiming in with my datapoint about my dad, who had a very similar experience during a kidney infection, which resolved fairly quickly once he was on the right antibiotics.

The funny (after it was over) bit was that Dad, during his infection-induced delirium, became convinced that he was either President Obama or Obama's chief speechwriter, and that he had to deliver or write an important speech. So for a couple of days, he was lying there bellowing random political platitudes a la "GOD BLESS AMERICA!" and "...the spirit that made this country great!" and so on.

Dad later referred to this as "my Obamamania."
posted by Sidhedevil at 8:34 PM on March 5, 2012 [1 favorite]

Sorry, I forgot the most important point; it took about four or five days for Dad to really regain his bearings. Even after he realized he was Mr. Sullivan, not Mr. Obama, he was haunted for a bit by the feeling he had a speech to write (not totally far fetched, as Dad was a writer as well as active in politics, and he had helped friends in public office with speeches in the past) for a couple more days.

Some heart medications can have mental confusion as a side effect, so if your dad's cardiologists changed any meds or dosages in response to the sepsis crisis, you might want to check in with them. But it sounds like it's probably directly connected to the sepsis.

Best to your dad and to you and your family.
posted by Sidhedevil at 8:41 PM on March 5, 2012

Thanks, everyone, for the good advice. He's now on Day 10 in the hospital and has been off the ventilator for five days. It's hard to tell if his delirium has subsided as he's mostly non-verbal and his awareness of his surroundings are limited. He gets a few words out from time to time but otherwise he's restless and agitated, regularly trying to climb out of the bed. The longer this continues, the more frightened we become that there's something more permanent at work than sepsis delirium.
posted by Jamesonian at 9:53 AM on March 6, 2012