Bodily and Cognitive Experience in Patients With Sepsis and Delirium or Subsyndromal Delirium.

BACKGROUND

Sepsis often causes cognitive changes like delirium and subsyndromal delirium (SSD). Delirium involves acute cognitive dysfunction, while SSD presents partial symptoms. Both conditions impact prognosis and are linked to neuroinflammation, altered cerebral perfusion and neurotransmitter dysfunction. This study explores the embodied cognitive experience in sepsis, integrating enactivist perspectives on the dynamic interplay of body, environment and neural activity.

AIM: To analyse the lived bodily and cognitive experiences of patients with sepsis who experienced delirium or SSD.

STUDY

DESIGN

A qualitative grounded theory study was conducted in a university hospital in Santiago of Chile. Adults with sepsis meeting SEPSIS-3 criteria and meeting at least one criterion on the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) positivity were included. Data were analysed using Corbin and Strauss's approach, applying open and axial coding to identify cognitive and bodily experience patterns.

FINDINGS: Ten semi-structured interviews (nine patients) were conducted before discharge. The study identified 20 subcategories of patients' bodily and cognitive experiences with delirium or SSD. In terms of bodily experiences, patients reported somatic depersonalization and loss of bodily control; pain and discomfort led to postural adjustments and eye closure as coping mechanisms. In the case of cognitive experiences, participants experienced visual hallucinations, distorted reality, disorientation and difficulty verbalising thoughts or understanding healthcare providers. Patients opened their eyes to confront visual stimuli and gradually recognized hallucinations as unreal, helping them reconnect with reality. Reported consequences following delirium or SSD included fragmented memories, fear of recurrence and perceived cognitive and physical decline.

CONCLUSIONS

Patients with sepsis and delirium or SSD experience disruptions in the lived body, including bodily and cognitive aspects such as pain, depersonalization, hallucinations, disorientation and communication difficulties, affecting emotional and cognitive functioning.

RELEVANCE TO CLINICAL PRACTICE: This study points to the need for non-pharmacological interventions that address cognitive, bodily and environmental aspects. Patient-centred care should ensure accessible environments and adequately trained personnel to support individuals experiencing delirium and SSD.