{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T13:00:28Z","timestamp":1790427628310,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Delirium in the Intensive Care Unit (ICU) is an acute neurocognitive syndrome affecting up to 80% of patients on mechanical ventilation. While traditionally defined by biomedical criteria (DSM\u20105), these metrics often overlook the profound ontological rupture and subjective alienation experienced by the patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Objectives<\/jats:title>\n                    <jats:p>This study aims to integrate clinical evidence with phenomenological reflection to evaluate how delirium alters patient identity and to define the resulting ethical responsibilities for the clinical team.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>An interdisciplinary conceptual analysis was conducted, merging pathophysiological data and clinical meta\u2010analyses with philosophical frameworks, including the phenomenology of perception, narrative identity and the ethics of vulnerability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Delirium suspends the \u2018intentional arc\u2019, leading to a collapse of the lived world, fragmented temporality and distorted otherness. Subphenotypes like hypoactive delirium often result in \u2018epistemic injustice\u2019 by silencing the patient's subjective testimony. Post\u2010Intensive Care Syndrome (PICS) is identified as a \u2018biographical disruption\u2019 and a wound to selfhood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Clinical evaluation must transcend pathophysiology to include \u2018narrative competence\u2019, enabling the reconstruction of the patient's fractured history. Bioethics should shift from abstract rational autonomy toward a model of \u2018relational autonomy\u2019 grounded in vulnerability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70583","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T07:51:35Z","timestamp":1788162695000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Phenomenology of a Biographical Disruption: Delirium in the Critically Ill Patient"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7021-3456","authenticated-orcid":false,"given":"A.","family":"Canabal\u2010Berlanga","sequence":"first","affiliation":[{"name":"Hospital Universitario de la Princesa Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3680-7055","authenticated-orcid":false,"given":"C.","family":"Alvargonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Hospital Universitario de la Princesa Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1453-1720","authenticated-orcid":false,"given":"B.","family":"Abad","sequence":"additional","affiliation":[{"name":"Hospital Universitario de la Princesa Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5603-7695","authenticated-orcid":false,"given":"E.","family":"Rosas","sequence":"additional","affiliation":[{"name":"Hospital Universitario de la Princesa Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-025-08167-7"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.2273"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787"},{"key":"e_1_2_13_5_1","volume-title":"Soi\u2010M\u00eame Comme Un Otro","author":"Ricoeur P.","year":"1990"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780199669653.001.0001"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9781139924184"},{"key":"e_1_2_13_8_1","volume-title":"Phenomenology of Perception","author":"Merleau\u2010Ponty M.","year":"2012"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.21555\/top.v0i61.1171"},{"key":"e_1_2_13_10_1","volume-title":"Sein und Zeit","author":"Heidegger M.","year":"2006"},{"key":"e_1_2_13_11_1","volume-title":"Zweiter Teil: Theorie der ph\u00e4nomenologischen Reduktion","author":"Husserl E.","year":"1956"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.947664"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcp.2017.02.004"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.4266\/acc.2019.00451"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11019-024-10214-5"},{"key":"e_1_2_13_16_1","volume-title":"La UCI les cur\u00f3 el cuerpo, pero les da\u00f1\u00f3 la mente","author":"XLSemanal","year":"2018"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/jnr.0000000000000384"},{"key":"e_1_2_13_18_1","unstructured":"Intensive Care Society.Guidance for: Delirium in the Critically Ill Patient.2026. 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