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A Pictorial Essay of Immunotherapy: Complications that Internists Will See, Whether They Like it or Not

A subject holding the “Joy for All” robotic cat in the surgical intensive care unit.

Delirium is highly prevalent in hospitalized patients and is a strong and consistent negative predictor of length of stay, mortality, and long-term cognitive outcomes.1 Symptoms commonly associated with delirium include reduced ability to focus, sleep disturbances, psychomotor agitation, and emotional disturbances. The management of the behavioral disturbances of delirium is challenging. Although non-pharmacologic means to reduce the duration or severity of delirium are advocated, there are limited established therapies beyond early physical mobilization, reorientation, attempting to enhance natural sleep patterns, and bedside sitting.1, 2

Recently, the use of robotic pets has been reported to be helpful in reducing agitation in nursing home patients with dementia.3, 4, 5 Given that dementia is a major risk factor for delirium, it is reasonable to speculate whether such devices could be useful in a hospital setting. To this end, we initiated a pilot study to assess the feasibility of using robotic pets as a non-pharmacologic behavioral intervention for intensive care unit (ICU) patients with delirium.

We recruited 20 subjects with ICU delirium, at our hospital, from July 2017 to December 2017. The institutional review board approved the study. Delirium was confirmed using the Confusion Assessment Method for the ICU scale.1 After written informed consent was obtained from the subject’s proxy, the subject received a new “Joy for All” robotic cat (Hasbro, Pawtucket, RI). The cat is battery-operated and can purr, meow, and react to touch. The family and bedside nurse were encouraged to use the cat with the subject (Figure). At 3 days post-enrollment, the subject (if able) and family (if available) were asked to complete a 5-question survey and to provide unstructured feedback. The same survey was e-mailed to all ICU nurses, support staff, and clinicians (n ∼ 400). Survey questions were graded on a 5-point Likert scale (from 1 [“strongly disagree”] to 5 [“strongly agree”]). Twenty-three surveys were returned from subjects and their families, and 70 were returned from ICU support staff.

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-Ashley Evens, MDa, George Cyriac, MDaDaniel Jeong, MD, MScb, Cyrillo Araujo, MDb, Kenneth Gage, MD, PhDb, Trevor Rose, MD, MPHb

This article originally appeared in the July 2019 issue of The American Journal of Medicine.

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