Case 36 of 40
Assess delirium, weakness and frightening memories separately after intensive care
Example case for staff education
Select an illustration to enlarge it.
Read the case transcript
Page 1
Panel 1: Before illness
Luis is independent before severe pneumonia.
Emma: He was managing everything as usual.
Panel 2: ICU week 1
Critical illness requires intensive treatment and sedation.
Panel 3: ICU week 2
After extubation, attention and understanding fluctuate.
Nurse Tom: I will ask one question at a time.
Panel 4: ICU week 2
Speech is difficult; staff help him express immediate needs.
Luis: Please stay near me.
Panel 5: ICU week 2
He interprets ordinary care as threatening.
Luis: They are waiting for me to make a mistake.
Panel 6: ICU week 2
Familiar support gives brief reassurance.
Emma: You are ill, and the team is helping you recover.
Panel 7: Week 3
The move is described repeatedly in simple terms.
Nurse Tom: Your breathing is better. The next ward will continue your care.
Panel 8: Week 3
Weakness and delirium remain after ICU transfer.
Luis: Why have you brought me here?
Panel 9: Week 3
The receiving team explains the change again.
Nurse Tom: I am your nurse today. We know you have been very unwell.
Page 2
Panel 10: Week 4
Physical rehabilitation begins in short sessions.
Physiotherapist Lin: We can stop and rest whenever you need.
Panel 11: Week 4
Cognition improves more gradually than breathing.
Ward doctor Amira: We will keep checking how he follows conversation and daily tasks.
Panel 12: Week 5
Frightening memories persist as attention improves.
Luis: I still remember being in danger.
Panel 13: Week 5
His experience is explored without confirming the remembered threat.
Ward doctor Amira: That sounds frightening. Tell me what you remember.
Panel 14: Week 6
A relative’s notes can help reconstruct the chronology.
Emma: We can look at a little when you want to.
Panel 15: Week 6
Reading the account is difficult; he controls the pace.
Luis: That is enough for today.
Panel 16: Month 2
Sleep, memories, cognition and physical function are assessed separately.
Ward doctor Amira: Which problems are affecting your day most now?
Panel 17: Month 3
Strength and attention improve; some memories remain distressing.
Luis: I understand more, but the feelings have not all gone.
Panel 18: Month 3
Recovery continues at different rates across different parts of life.
Ward doctor Amira: We can keep working through this at your pace.
Sources
- [S34] Brice, A.E. and Brice, R.G. (2024) ‘A Case Report and Review of the Literature of ICU Delirium’, Healthcare, 12(15), 1506.
- [S35] Gallie, L. (2024) ‘Delirium: name it, say it: loud and clear’, Intensive Care Medicine, 50(2), pp. 314–316.
- [S36] Richards, D. (2023) ‘Transitioning to reality: the diary of an ARDS survivor’, Intensive Care Medicine, 49(12), pp. 1571–1575.
- [S37] Stańska, A., Klapkowski, A., Karolak, W. and Brzeziński, M. (2026) ‘Case Report: Persistent delusional memories after postoperative delirium in a woman with complex cardiac surgical history’, Frontiers in Psychiatry, 16, 1743329.
- [T01] MacLullich AMJ. Conceptualising distress in delirium. Usher teaching presentation, May 2026. Teaching slides.
Commentary
Luis has critical illness, receives sedation and develops delirium as he wakes. His later memories need to be distinguished from events observed during delirium. He initially struggles to communicate because he is weak and confused. After his attention improves, he still needs help understanding what he remembers.
Transfer to a general ward changes both the surroundings and the amount of immediate support. Give a clear handover and explain the move repeatedly, because Luis may not understand why it is happening. Continue rehabilitation, assessment of thinking and discussion of fear together. Patient accounts describe these transitions as part of recovery, with continuing difficulties after transfer [S34–S36].
Emma’s notes describe the order of events. Luis reads them gradually, with help and at his own pace. The case does not claim that a diary reliably corrects beliefs or prevents trauma. Richards describes finding such material difficult to read. Gallie describes the need for an explanation of delirium and access to follow-up [S35, S36].
At three months, Luis can hold a coherent conversation and do more physically, but some memories remain distressing. Distressing memories do not by themselves establish continuing delirium. Assess current attention, alertness, daily activities, sleep and psychological symptoms separately [S37, T01]. Continue follow-up because these difficulties can improve at different rates.