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Maldonado JR. Acute Brain Failure: Pathophysiology, Diagnosis, Management, and Sequelae of Delirium. Crit Care Clin 2017; 33:461-519. [PMID: 28601132 DOI: 10.1016/j.ccc.2017.03.013] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Delirium is the most common psychiatric syndrome found in the general hospital setting, with an incidence as high as 87% in the acute care setting. Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. The development of delirium is associated with increased morbidity, mortality, cost of care, hospital-acquired complications, placement in specialized intermediate and long-term care facilities, slower rate of recovery, poor functional and cognitive recovery, decreased quality of life, and prolonged hospital stays. This article discusses the epidemiology, known etiological factors, presentation and characteristics, prevention, management, and impact of delirium.
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Affiliation(s)
- José R Maldonado
- Psychosomatic Medicine Service, Emergency Psychiatry Service, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Suite 2317, Stanford, CA 94305-5718, USA.
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Kroll RR, McKenzie ED, Boyd JG, Sheth P, Howes D, Wood M, Maslove DM. Use of wearable devices for post-discharge monitoring of ICU patients: a feasibility study. J Intensive Care 2017; 5:64. [PMID: 29201377 PMCID: PMC5698959 DOI: 10.1186/s40560-017-0261-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/08/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Wearable devices generate signals detecting activity, sleep, and heart rate, all of which could enable detailed and near-continuous characterization of recovery following critical illness. METHODS To determine the feasibility of using a wrist-worn personal fitness tracker among patients recovering from critical illness, we conducted a prospective observational study of a convenience sample of 50 stable ICU patients. We assessed device wearability, the extent of data capture, sensitivity and specificity for detecting heart rate excursions, and correlations with questionnaire-derived sleep quality measures. RESULTS Wearable devices were worn over a 24-h period, with excellent capture of data. While specificity for the detection of tachycardia was high (98.8%), sensitivity was low to moderate (69.5%). There was a moderate correlation between wearable-derived sleep duration and questionnaire-derived sleep quality (r = 0.33, P = 0.03). Devices were well-tolerated and demonstrated no degradation in quality of data acquisition over time. CONCLUSIONS We found that wearable devices could be worn by patients recovering from critical illness and could generate useful data for the majority of patients with little adverse effect. Further development and study are needed to better define and enhance the role of wearables in the monitoring of post-ICU recovery. TRIAL REGISTRATION Clinicaltrials.gov, NCT02527408.
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Affiliation(s)
- Ryan R. Kroll
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
| | | | - J. Gordon Boyd
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
| | - Prameet Sheth
- Department of Pathology and Molecular Medicine, Queen’s University and Health Sciences Centre, Kingston, Ontario Canada
| | - Daniel Howes
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Emergency Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
| | - Michael Wood
- Department of Neuroscience, Queen’s University, Kingston, Ontario Canada
| | - David M. Maslove
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Kingston Health Sciences Centre, Kingston General Hospital, Davies 2, 76 Stuart St., Kingston, Ontario K7L 2V7 Canada
| | - for the WEARable Information Technology for hospital INpatients (WEARIT-IN) study group
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- School of Medicine, Queen’s University, Kingston, Ontario Canada
- Department of Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Pathology and Molecular Medicine, Queen’s University and Health Sciences Centre, Kingston, Ontario Canada
- Department of Emergency Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Neuroscience, Queen’s University, Kingston, Ontario Canada
- Kingston Health Sciences Centre, Kingston General Hospital, Davies 2, 76 Stuart St., Kingston, Ontario K7L 2V7 Canada
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Affiliation(s)
- Biren B Kamdar
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA.
| | - Jennifer L Martin
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research Education and Clinical Center, Los Angeles, California, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
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Affiliation(s)
- Biren B Kamdar
- Division of Pulmonary and Critical Care Medicine Department of Medicine David Geffen School of Medicine at UCLA Los Angeles, CADepartment of Medicine David Geffen School of Medicine at UCLA University of California; and Geriatric Research, Education and Clinical Center VA Greater Los Angeles Healthcare System Los Angeles, CAOutcomes After Critical Illness and Surgery (OACIS) Group Division of Pulmonary & Critical Care Medicine Department of Physical Medicine & Rehabilitation Johns Hopkins University Baltimore, MDDivision of General Internal Medicine and Health Services Research Department of Medicine David Geffen School of Medicine at UCLA University of California; and VA Greater Los Angeles Healthcare System Los Angeles, CA
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