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Hsiao WL, Hsieh PY, Hsu LF, Lai YH, Wang ML, Yeh YC. Effectiveness of a delirium risk assessment and multidisciplinary care approach in reducing delirium incidence among surgical intensive care unit patients: A retrospective pre-post intervention study. J Clin Anesth 2024; 98:111566. [PMID: 39084094 DOI: 10.1016/j.jclinane.2024.111566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 07/21/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Delirium is a common complication in intensive care unit (ICU) patients. It can lead to various adverse events. In this study, we investigated the effectiveness of combining the use of the PREdiction of DELIRium (PRE-DELIRIC) model for delirium risk assessment and the use of a multicomponent care bundle for delirium assessment, prevention, and care in terms of reductions in the incidence of delirium among surgical ICU patients. METHODS This retrospective study included surgical ICU patients who had received PRE-DELIRIC-guided SMART/SmART care (SMART care: SmART bundle plus multidisciplinary team; SmART care: Sleep/sweet sense of home (creating a comforting and restful environment for patients), Assessment (regular and thorough evaluation of patient needs and conditions), Release (revised endotracheal tube care/removal, restraint device care, and immobility reduction for patient comfort), and Time (reorientation of time to optimize patient care schedules) in our hospital between May 2022 and March 2023 (intervention group) and individuals who had received usual care between January 2021 and April 2022 (historical control group). The SmART intervention involves providing care in the following domains: sleep/sweet sense of home, assessment, release, and time. Patients with a PRE-DELIRIC score of >30% received SMART care, which includes multidisciplinary (physicians, pharmacists, respiratory therapists, and physiotherapists) care in addition to SmART care. For the control group, usual care was provided following the guidelines for the prevention and management of pain, agitation, delirium, immobility, and sleep disruption. The primary outcome was delirium incidence during ICU stay, which was assessed using the Intensive Care Delirium Screening Checklist. The secondary outcomes were the duration of ICU stay, rate of unplanned self-extubation, and status of ICU discharge. RESULTS The intervention and control groups comprised 184 and 197 patients, respectively; their mean ages were 63.7 ± 18.4 years and 62.4 ± 19.5 years, respectively. The incidence of delirium was significantly lower (p = 0.001) in the intervention group (22.3%) than in the control group (47.7%). CONCLUSION Our findings suggest that the PRE-DELIRIC-guided SMART/SmART care intervention is effective in preventing and managing delirium among surgical ICU patients.
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Affiliation(s)
- Wei-Ling Hsiao
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan; School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Yin Hsieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Fang Hsu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yeur-Hur Lai
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nursing, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yu-Chang Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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Flim M, Rustøen T, Blackwood B, Spronk PE. Thirst in adult patients in the intensive care unit: A scoping review. Intensive Crit Care Nurs 2024; 86:103787. [PMID: 39182324 DOI: 10.1016/j.iccn.2024.103787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE To review the literature on thirst in intensive care unit (ICU) patients and report potential causes, risk factors, diagnosis and measurement tools, as well as potential co-occurrence with other distressing symptoms, and the management of thirst in the ICU. DESIGN A scoping review employing the Joanna Briggs Institute methodology. METHODS PubMed, MEDLINE, EMBASE and CINAHL were searched from inception to April 2024. Any type of empirical study reporting thirst or associated xerostomia in adult patients (≥18 years) admitted to an ICU or high dependency unit for more than 24 h were included. RESULTS The search yielded 907 unique records, and after evaluating 65 full-text publications, 21 studies were included. Thirst intensity was addressed most often (eleven studies), whereas the experience (or quality) of thirst and the validation of a measurement instrument, were addressed in only one study. Although co-occurrence of symptoms was addressed in four studies, only one pilot study looked into the interaction of thirst with other symptoms. Intervention studies have been focussing primarily on mouth-care interventions. CONCLUSION Thirst is a distressing symptom in the ICU, with reported high prevalence and intensity. Knowledge about its causes, interventions that incorporate minimising its risk, occurrence and intensity are limited. IMPLICATIONS FOR CLINICAL PRACTICE Health care providers should acknowledge thirst as a prominent symptom for ICU patients. They should possess knowledge on the factors that potentially evoke or aggravate thirst. Regular and timely relief of thirst by oral care with cold swabs and the application of menthol can be regarded as a first choice of intervention.
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Affiliation(s)
- Marleen Flim
- Gelre Hospitals, department of intensive care, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, the Netherlands; Expertise centre for Intensive Care Rehabilitation Apeldoorn (ExpIRA), Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, the Netherlands.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, PD 1089 Blindern, 0318 Oslo, Norway
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, 97 Lisburn road, Belfast BT9 7BL, Northern Ireland
| | - Peter E Spronk
- Gelre Hospitals, department of intensive care, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, the Netherlands; Expertise centre for Intensive Care Rehabilitation Apeldoorn (ExpIRA), Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, the Netherlands
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den Boogaard MV, Leenders M, Pop-Purceleanu M, Tilburgs B. Performance and validation of two ICU delirium assessment and severity tools; a prospective observational study. Intensive Crit Care Nurs 2024; 83:103627. [PMID: 38301387 DOI: 10.1016/j.iccn.2024.103627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The clinical statistical performance of the Confusion Assessment Method Intensive Care Unit (CAM-ICU, including CAM-ICU-7) and Intensive Care Delirium Screening Checklist (ICDSC) have rarely been studied. Additionally, delirium severity is often not measured due to a lack of validation of delirium assessment tools. OBJECTIVE The aim was to determine the statistical performance of both delirium assessment tools in daily practice, and the correlation with the gold standard Delirium Rating Scale (DRS)-R98, for delirium severity. RESEARCH METHOD CAM-ICU-7 and ICDSC, performed by nurses were compared with the DRS-R98 assessed by delirium experts, twice weekly. Within a time-window of one hour all assessments were independently performed. DESIGN A prospective observational study performed between October and December 2020. MAIN OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive value of both tools was determined. The correlation between DRS-R98 and CAM-ICU-7 and ICDSC was used for validation of delirium severity. RESULTS In total, 104 CAM-ICU-7 and 105 ICDSC assessments in 86 patients were compared with the DRS-R98. For the CAM-ICU-7 and ICDSC, respectively, the sensitivity was 90% and 95%, the specificity was 92.4% and 92.3%. The positive predictive value was 0.76 and 0.80, and negative predictive value was 0.77 and 0.97. Correlation of the CAM-ICU-7 score and ICDSC score with the DRS-R98 score was 0.74 (95% CI 0.64-0.81) and 0.70 (95%CI 0.59-0.79; both p < 0.001), respectively. CONCLUSION Both CAM-ICU-7 and ICDSC demonstrated good statistical performance and correlated well with the delirium severity tool DRS-R98. IMPLICATIONS FOR CLINICAL PRACTICE Nurses can either use the CAM-ICU(-7) or the ICDSC in their practice, both are accurate in delirium diagnosis. Total CAM-ICU-7 and ICDSC score reflects delirium severity well; the higher the score, the more severe the delirium. This enables nurses to gauge the impact of their interventions and enhance the well-being of patients experiencing delirium by minimizing distressing occurrences.
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Affiliation(s)
- Mark van den Boogaard
- Radboud University Medical Center, Department Intensive Care, Nijmegen, the Netherlands.
| | - Margot Leenders
- Radboud University Medical Center, Department Intensive Care, Nijmegen, the Netherlands
| | - Monica Pop-Purceleanu
- Radboud University Medical Center, Department of Psychiatrie, Nijmegen, the Netherlands
| | - Bram Tilburgs
- Radboud University Medical Center, Department Intensive Care, Nijmegen, the Netherlands
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Taylor J, Wilcox ME. Physical and Cognitive Impairment in Acute Respiratory Failure. Crit Care Clin 2024; 40:429-450. [PMID: 38432704 DOI: 10.1016/j.ccc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Recent research has brought renewed attention to the multifaceted physical and cognitive dysfunction that accompanies acute respiratory failure (ARF). This state-of-the-art review provides an overview of the evidence landscape encompassing ARF-associated neuromuscular and neurocognitive impairments. Risk factors, mechanisms, assessment tools, rehabilitation strategies, approaches to ventilator liberation, and interventions to minimize post-intensive care syndrome are emphasized. The complex interrelationship between physical disability, cognitive dysfunction, and long-term patient-centered outcomes is explored. This review highlights the need for comprehensive, multidisciplinary approaches to mitigate morbidity and accelerate recovery.
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Affiliation(s)
- Jonathan Taylor
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA
| | - Mary Elizabeth Wilcox
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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Ho MH, Lee JJ, Lai PCK, Li PWC. Prevalence of delirium among critically ill patients who received extracorporeal membrane oxygenation therapy: A systematic review and proportional meta-analysis. Intensive Crit Care Nurs 2023; 79:103498. [PMID: 37562998 DOI: 10.1016/j.iccn.2023.103498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES To pool the overall prevalence of delirium among critically ill patients who received extracorporeal membrane oxygenation (ECMO) support. METHODOLOGY This systematic review and proportional meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Six electronic databases including PubMed, Cochrane Library, Web of Science, EMBASE, CINAHL, and PsycINFO were searched from inception to March 2023. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. A random effects model was used to pool the summary prevalence estimates and 95% CIs using the score statistic and the exact binomial method and incorporates the Freeman-Tukey double arcsine transformation of proportions. Sensitivity analyses including subgroup analysis, meta-regression, and outlier detection were carried out. SETTING Intensive care units. MAIN OUTCOME MEASURES Prevalence of delirium. RESULTS A total of 10 studies involving 8,580 patients were included for meta-analysis. All studies had a low risk of bias in methodological quality. The pooled prevalence rate of 40.79% [95% CI, 17.58%-66.25%] was observed. The between-study heterogeneity (I2) was 98.28%. The subgroup analysis reveals the pooled prevalence of delirium for veno-arterial (V-A) ECMO, veno-venous (V-V) ECMO, and mixed sample of V-A and V-V ECMO were 63.57% [95% CI, 55.77%-71.04%], 51.84% [95% CI, 37.43%-66.12%] and 35.23% [95% CI, 11.84%-62.95%], respectively. Sample size (p = 0.024) was a significant factor associated with the heterogeneity. No evidence for small-study effects was observed (Egger's test: p = 0.5664). CONCLUSION This systematic review and proportional meta-analysis reveals a high prevalence of delirium among critically ill patients who received ECMO support. IMPLICATIONS FOR CLINICAL PRACTICE The results of this meta-analysis can be epidemiological evidence to inform the awareness of clinicians and researchers in critical care clinical practice and research.
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Affiliation(s)
- Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Peter Chi Keung Lai
- Adult Intensive Care Unit, Queen Mary Hospital, Hospital Authority of Hong Kong, Hong Kong.
| | - Polly Wai Chi Li
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
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Cheng J, Lao Y, Chen X, Qiao X, Sui W, Gong X, Zhuang Y. Dynamic Nomogram for Subsyndromal Delirium in Adult Intensive Care Unit: A Prospective Cohort Study. Neuropsychiatr Dis Treat 2023; 19:2535-2548. [PMID: 38029051 PMCID: PMC10676691 DOI: 10.2147/ndt.s432776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To develop a dynamic nomogram of subsyndromal delirium (SSD) in intensive care unit (ICU) patients and internally validate its efficacy in predicting SSD. Patients and Methods Patients who met the inclusion and exclusion criteria in the ICU of a tertiary hospital in Zhejiang from September 2021 to June 2022 were selected as the research objects. The patient data were randomly divided into the training set and validation set according to the ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were used to screen the predictors of SSD, and R software was used to construct a dynamic nomogram. Receiver operating characteristic (ROC) curve, calibration band and decision curve were used to evaluate the discrimination, calibration and clinical effectiveness of the model. Results A total of 1000 eligible patients were included, including 700 in the training set and 300 in the validation set. Age, drinking history, C reactive protein level, APACHE II, indwelling urinary catheter, mechanical ventilation, cerebrovascular disease, respiratory failure, constraint, dexmedetomidine, and propofol were predictors of SSD in ICU patients. The ROC curve values of the training set was 0.902 (95% confidence interval: 0.879-0.925), the best cutoff value was 0.264, the specificity was 78.4%, and the sensitivity was 88.0%. The ROC curve values of the validation set was 0.888 (95% confidence interval: 0.850-0.930), the best cutoff value was 0.543, the specificity was 94.9%, and the sensitivity was 70.9%. The calibration band showed good calibration in the training and validation set. Decision curve analysis showed that the net benefit in the model was significantly high. Conclusion The dynamic nomogram has good predictive performance, so it is a precise and effective tool for medical staff to predict and manage SSD in the early stage.
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Affiliation(s)
- Junning Cheng
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Yuewen Lao
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Xiangping Chen
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Xiaoting Qiao
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Weijing Sui
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Xiaoyan Gong
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Yiyu Zhuang
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
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van der Heijden EFM, Kooken RWJ, Zegers M, Simons KS, van den Boogaard M. Differences in long-term outcomes between ICU patients with persistent delirium, non-persistent delirium and no delirium: A longitudinal cohort study. J Crit Care 2023; 76:154277. [PMID: 36804824 DOI: 10.1016/j.jcrc.2023.154277] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/18/2023] [Accepted: 02/03/2023] [Indexed: 02/20/2023]
Abstract
PURPOSE Determine differences in physical, mental and cognitive outcomes 1-year post-ICU between patients with persistent delirium (PD), non-persistent delirium (NPD) and no delirium (ND). MATERIALS AND METHODS A longitudinal cohort study was performed in adult ICU patients of two hospitals admitted between July 2016-February 2020. Questionnaires on physical, mental and cognitive health, frailty and QoL were completed regarding patients' pre-ICU health status and 1-year post-ICU. Delirium data were from patients' total hospital stay. Patients were divided in PD (≥14 days delirium), NPD (<14 days delirium) or ND patients. RESULTS 2400 patients completed both questionnaires, of whom 529 (22.0%) patients developed delirium; 35 (6.6%) patients had PD and 494 (93.4%) had NPD. Patients with delirium (PD or NPD) had worse outcomes in all domains compared to ND patients. Compared to NPD, more PD patients were frail (34.3% vs. 14.6%, p = 0.006) and fatigued (85.7% vs. 61.1%, p = 0.012). After adjustment, PD was significantly associated with long-term cognitive impairment only (aOR 3.90; 95%CI 1.31-11.63). CONCLUSIONS Patients with PD had a higher likelihood to develop cognitive impairment 1-year post-ICU compared to NPD or ND. Patients with PD and NPD were more likely to experience impairment on all health domains (i.e. physical, mental and cognitive), compared to ND patients.
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Affiliation(s)
- Emma F M van der Heijden
- Jeroen Bosch Hospital, Department of Intensive Care Medicine, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, the Netherlands.
| | - Rens W J Kooken
- Radboud University Medical Center, Department of Intensive Care, Radboud Institute for Health Science710 - Research IC (room 24), P.O. 9101, zipcode 6500HB, Nijmegen, the Netherlands.
| | - Marieke Zegers
- Radboud University Medical Center, Department of Intensive Care, Radboud Institute for Health Science710 - Research IC (room 24), P.O. 9101, zipcode 6500HB, Nijmegen, the Netherlands.
| | - Koen S Simons
- Jeroen Bosch Hospital, Department of Intensive Care Medicine, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, the Netherlands.
| | - Mark van den Boogaard
- Radboud University Medical Center, Department of Intensive Care, Radboud Institute for Health Science710 - Research IC (room 24), P.O. 9101, zipcode 6500HB, Nijmegen, the Netherlands.
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Tiwari AM, Zirpe KG, Khan AZ, Gurav SK, Deshmukh AM, Suryawanshi PB, Kapse US, Wankhede PP, Bamne SN, Bhoyar AP, Malhotra RV, Sontakke SM, Borade PB. Incidence, Subtypes, Risk factors, and Outcome of Delirium: A Prospective Observational Study from Indian Intensive Care Unit. Indian J Crit Care Med 2023; 27:111-118. [PMID: 36865510 PMCID: PMC9973060 DOI: 10.5005/jp-journals-10071-24407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
Background Delirium is a common, under-recognized, and often fatal condition in critically ill patients, characterized by acute disorder of attention and cognition. The global prevalence varies with a negative impact on outcomes. A paucity of Indian studies exists that have systematically assessed delirium. Objective A prospective observational study designed to determine the incidence, subtypes, risk factors, complications, and outcome of delirium in Indian intensive care units (ICUs). Patients and methods Among 1198 adult patients screened during the study period (December 2019-September 2021), 936 patients were included. The confusion assessment method score (CAM-ICU) and Richmond agitation sedation scale (RASS) were used, with additional confirmation of delirium by the psychiatrist/neurophysician. Risk factors and related complications were compared with a control group. Results Delirium occurred in 22.11% of critically ill patients. The hypoactive subtype was the most common (44.9%). The risk factors recognized were higher age, increased acute physiology and chronic health evaluation (APACHE-II) score, hyperuricemia, raised creatinine, hypoalbuminemia, hyperbilirubinemia, alcoholism, and smoking. Precipitating factors included patients admitted on noncubicle beds, proximity to the nursing station, requiring ventilation, as well as the use of sedatives, steroids, anticonvulsants, and vasopressors. Complications observed in the delirium group were unintentional removal of catheters (35.7%), aspiration (19.8%), need for reintubation (10.6%), decubitus ulcer formation (18.4%), and high mortality (21.3% vs 5%). Conclusion Delirium is common in Indian ICUs with a potential effect on length of stay and mortality. Identification of incidence, subtype, and risk factors is the first step toward prevention of this important cognitive dysfunction in the ICU. How to cite this article Tiwari AM, Zirpe KG, Khan AZ, Gurav SK, Deshmukh AM, Suryawanshi PB, et al. Incidence, Subtypes, Risk factors, and Outcome of Delirium: A Prospective Observational Study from Indian Intensive Care Unit. Indian J Crit Care Med 2023;27(2):111-118.
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Affiliation(s)
- Anand Mohanlal Tiwari
- Department of Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India,Anand Mohanlal Tiwari, Department of Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India, Phone: +91 7798255626, e-mail:
| | | | | | | | | | | | | | | | | | | | | | | | - Pankaj B Borade
- Department of Psychiatry, Ruby Hall Clinic, Pune, Maharashtra, India
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Papaioannou M, Papastavrou E, Kouta C, Tsangari H, Merkouris A. Investigating nurses' knowledge and attitudes about delirium in older persons: a cross-sectional study. BMC Nurs 2023; 22:10. [PMID: 36631856 PMCID: PMC9832247 DOI: 10.1186/s12912-022-01158-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Delirium is the most common emergency for older hospitalized patients that demands urgent treatment, otherwise it can lead to more severe health conditions. Nurses play a crucial part in diagnosing delirium and their competencies facilitate the appropriate treatment and management of the condition. AIM This study aims to enhance the understanding of delirium care by exploring both knowledge and attitudes of nurses toward patients in acute care hospital wards and the possible association between these two variables. METHOD The Nurses Knowledge of Delirium Questionnaire (NKD) and the Attitude Tool of Delirium (ATOD) that were created for the said inquiry, were disseminated to 835 nurses in the four largest Public Hospitals of the Republic. These tools focused particularly on departments with increased frequency of delirium (response rate = 67%). RESULTS Overall nurses have limited knowledge of acute confusion/delirium. The average of correct answers was 42.2%. Only 38% of the participants reported a correct definition of delirium, 41.6 correctly reported the tools to identify delirium and 42.5 answered correctly on the factors leading to delirium development. The results of the attitudes' questionnaire confirmed that attitudes towards patients with delirium may not be supportive enough. A correlation between the level of nurses' knowledge and their attitude was also found. The main factors influencing the level of knowledge and attitudes were gender, education, and workplace. CONCLUSION The findings of this study are useful for the international audience since they can be used to develop and modify educational programmes in order to rectify the knowledge deficits and uninformed attitudes towards patients with delirium. The development of a valid and reliable instrument for the evaluation of attitudes will help to further assess nurses' attitudes. Furthermore, the results are even more important and useful on a national level since there is no prior data on the subject area, making this study the first of its kind.
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Affiliation(s)
- Maria Papaioannou
- grid.15810.3d0000 0000 9995 3899Cyprus University of Technology, Limassol, Cyprus
| | - Evridiki Papastavrou
- grid.15810.3d0000 0000 9995 3899Cyprus University of Technology, Limassol, Cyprus
| | - Christiana Kouta
- grid.15810.3d0000 0000 9995 3899Cyprus University of Technology, Limassol, Cyprus
| | - Haritini Tsangari
- grid.413056.50000 0004 0383 4764University of Nicosia, Nicosia, Cyprus
| | - Anastasios Merkouris
- grid.15810.3d0000 0000 9995 3899Cyprus University of Technology, Limassol, Cyprus
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Amerongen HVN, Stapel S, Spijkstra JJ, Ouweneel D, Schenk J. Comparison of Prognostic Accuracy of 3 Delirium Prediction Models. Am J Crit Care 2023; 32:43-50. [PMID: 36587002 DOI: 10.4037/ajcc2023213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Delirium is a severe complication in critical care patients. Accurate prediction could facilitate determination of which patients are at risk. In the past decade, several delirium prediction models have been developed. OBJECTIVES To compare the prognostic accuracy of the PRE-DELIRIC, E-PRE-DELIRIC, and Lanzhou models, and to investigate the difference in prognostic accuracy of the PRE-DELIRIC model between patients receiving and patients not receiving mechanical ventilation. METHODS This retrospective study involved adult patients admitted to the intensive care unit during a 2-year period. Delirium was assessed by using the Confusion Assessment Method for the Intensive Care Unit or any administered dose of haloperidol or quetiapine. Model discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC); values were compared using the DeLong test. RESULTS The study enrolled 1353 patients. The AUC values were calculated as 0.716 (95% CI, 0.688-0.745), 0.681 (95% CI, 0.650-0.712), and 0.660 (95% CI, 0.629-0.691) for the PRE-DELIRIC, E-PRE-DELIRIC, and Lanzhou models, respectively. The difference in model discrimination was statistically significant for comparison of the PRE-DELIRIC with the E-PRE-DELIRIC (AUC difference, 0.035; P = .02) and Lanzhou models (AUC difference, 0.056; P < .001). In the PRE-DELIRIC model, the AUC was 0.711 (95% CI, 0.680-0.743) for patients receiving mechanical ventilation and 0.664 (95% CI, 0.586-0.742) for those not receiving it (difference, 0.047; P = .27). CONCLUSION Statistically significant differences in prognostic accuracy were found between delirium prediction models. The PRE-DELIRIC model was the best-performing model and can be used in patients receiving or not receiving mechanical ventilation.
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Affiliation(s)
- Hilde van Nieuw Amerongen
- Hilde van Nieuw Amerongen is a registered nurse and clinical epidemiologist, Department of Intensive Care, Amsterdam UMC (VUmc), Amsterdam, the Netherlands
| | - Sandra Stapel
- Sandra Stapel is an intensivist, Department of Intensive Care, Amsterdam UMC (VUmc), Amsterdam, the Netherlands
| | - Jan Jaap Spijkstra
- Jan Jaap Spijkstra is an intensivist, Department of Intensive Care, Amsterdam UMC (VUmc), Amsterdam, the Netherlands
| | - Dagmar Ouweneel
- Dagmar Ouweneel is a clinical data specialist, Department of Intensive Care, Amsterdam UMC (VUmc), Amsterdam, the Netherlands
| | - Jimmy Schenk
- Jimmy Schenk is a registered nurse, a PhD candidate in the Department of Anesthesiology, and a clinical epidemiologist in the Department of Epidemiology and Data Science and the Department of Anesthesiology, Amsterdam UMC (Academic Medical Center), Amsterdam, the Netherlands
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Zapata C, Garces JJ, Duica K, Restrepo C, Ocampo MV, Velásquez-Tirado JD, Ricardo C, Trzepacz PT, Franco JG. Variables associated with concordance or discordance for delirium diagnosis between referring and consulting physicians at a Tertiary Hospital in Colombia: Prospective observational study. Medicine (Baltimore) 2022; 101:e32096. [PMID: 36626485 PMCID: PMC9750523 DOI: 10.1097/md.0000000000032096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Delirium is an acute state of impaired consciousness and a medical urgency. Its broad range of alterations in mental status make diagnosis challenging. Awareness and accurate provisional diagnosis by nonpsychiatric clinicians are important for prompt management. Because delirium symptoms overlap and mimic other neuropsychiatric conditions, a referral to a consultant psychiatrist is often needed. The aim of this study was to determine the discriminating variables that are associated with concordance or discordance for a DSM-5 delirium diagnosis made by the consultation/liaison (C/L) psychiatrist as compared to the referral diagnosis/reasons given by the referring physicians for inpatients from a Tertiary Hospital in a Latin-American country. Prospective study of a cohort of 399 consecutive patients admitted to any ward of a university hospital in Medellin-Colombia and referred by a specialist physician to the C/L Psychiatry service. Analyses for diagnostic concordance used a nested sample of 140 cases diagnosed with delirium by the psychiatrist. Two multivariate logistic models were run, for delirium diagnosis concordance and discordance between the referring physician and C/L psychiatrist. The referral diagnosis was concordant with that of Psychiatry in 90/140 patients in 64.3%, with 35.7% discordance. Increasing age (OR = 1.024) and internal medicine ward (OR = 3.0) were significantly related (Wald statistic P < .05) to concordance in the multivariate analysis whose model accuracy was 68.6%. Trauma/orthopedics ward (OR = 5.7) and SARS-CoV-2 infection (OR = 3.8) were important contributors to the model fit though not significant. Accuracy of the discordance model was 70.7%, where central nervous system (CNS) disorder (OR = 6.1) and referrals from ICU (OR = 4.9), surgery (OR = 4.6), neurology/neurosurgery (OR = 5.1) and another consultant (OR = 4.7) were significantly related (Wald statistic P < .05), while metabolic/endocrine disorder (OR = 2.7) was important for model fit, but not significant. Concordance for delirium diagnosis was higher from services where education, guidelines and working relationships with C/L Psychiatry could have contributed beneficially whereas, surprisingly, CNS disorders and neurology/neurosurgery services had higher discordance, as well as the ICU. Routine use of brief sensitive delirium assessment tools such as the DDT-Pro could enhance provisional delirium diagnosis.
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Affiliation(s)
- Carolina Zapata
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Juan J. Garces
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Kelly Duica
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Cristóbal Restrepo
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - María V. Ocampo
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Juan D. Velásquez-Tirado
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Carmenza Ricardo
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Paula T. Trzepacz
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - José G. Franco
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
- * Correspondence: José G. Franco, Facultad de Medicina de la Universidad Pontificia Bolivariana (Campus Robledo), Medellín 050036, Colombia (e-mail: )
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12
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Flim M, Rustøen T, Blackwood B, Spronk P. Thirst in adult patients in the intensive care unit: protocol for a scoping review. BMJ Open 2022; 12:e063006. [PMID: 36446463 PMCID: PMC9710361 DOI: 10.1136/bmjopen-2022-063006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Thirst is one of the most bothersome symptoms experienced by intensive care unit (ICU) patients. Effective diagnosis and management of thirst in the ICU is essential, particularly as patients are less sedated than previously and more aware of this problem. Currently, no overview of publications on thirst identification and management in ICU patients exists. The scoping review will address the broad question 'What is known about thirst as a symptom in adult critically ill patients?' It aims to provide an overview of the causes and risk factors, diagnosis and measurement, the symptom dimensions and its interaction with other symptoms, and thirst management. METHODS AND ANALYSIS The review will follow the Joanna Briggs Institute methodology framework to guide the process and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Methods include: defining the review questions, eligibility criteria, concepts of interest and context; and outlining the search strategy, study selection process, data extraction and analysis. PubMed, MEDLINE, EMBASE and CINAHL will be searched from inception to April 2022. ETHICS AND DISSEMINATION Ethical approval is not required, as the scoping review will synthesise information from available publications. The scoping review will be submitted for publication to a scientific journal, presented at relevant conferences and disseminated as part of future workshops with ICU support groups and the critical care professional community.
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Affiliation(s)
- Marleen Flim
- Intensive Care, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
- Expertise centre for Intensive Care Rehabilitation Apeldoorn (ExpIRA), Apeldoorn, The Netherlands
| | - Tone Rustøen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo universitetssykehus Ulleval, Oslo, Norway
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Peter Spronk
- Intensive Care, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
- Expertise centre for Intensive Care Rehabilitation Apeldoorn (ExpIRA), Apeldoorn, The Netherlands
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13
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Kotfis K, van Diem-Zaal I, Williams Roberson S, Sietnicki M, van den Boogaard M, Shehabi Y, Ely EW. The future of intensive care: delirium should no longer be an issue. Crit Care 2022; 26:200. [PMID: 35790979 PMCID: PMC9254432 DOI: 10.1186/s13054-022-04077-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 01/02/2023] Open
Abstract
In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A-F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a 'home-like' (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.
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Affiliation(s)
- Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Szczecin, Poland.
| | - Irene van Diem-Zaal
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Shawniqua Williams Roberson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Center for Health Services Research, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Marek Sietnicki
- Department of Architecture, West Pomeranian University of Technology in Szczecin, Szczecin, Poland
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Yahya Shehabi
- Monash Health School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.,School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Center for Health Services Research, Nashville, TN, USA.,Division of Allergy, Department of Medicine, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Geriatric Research, Education and Clinical Center (GRECC) Service, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
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14
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Lewis K, Alshamsi F, Carayannopoulos KL, Granholm A, Piticaru J, Al Duhailib Z, Chaudhuri D, Spatafora L, Yuan Y, Centofanti J, Spence J, Rochwerg B, Perri D, Needham DM, Holbrook A, Devlin JW, Nishida O, Honarmand K, Ergan B, Khorochkov E, Pandharipande P, Alshahrani M, Karachi T, Soth M, Shehabi Y, Møller MH, Alhazzani W. Dexmedetomidine vs other sedatives in critically ill mechanically ventilated adults: a systematic review and meta-analysis of randomized trials. Intensive Care Med 2022; 48:811-840. [PMID: 35648198 DOI: 10.1007/s00134-022-06712-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/18/2022] [Indexed: 12/17/2022]
Abstract
Conventional gabaminergic sedatives such as benzodiazepines and propofol are commonly used in mechanically ventilated patients in the intensive care unit (ICU). Dexmedetomidine is an alternative sedative that may achieve lighter sedation, reduce delirium, and provide analgesia. Our objective was to perform a comprehensive systematic review summarizing the large body of evidence, determining if dexmedetomidine reduces delirium compared to conventional sedatives. We searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov and the WHO ICTRP from inception to October 2021. Independent pairs of reviewers identified randomized clinical trials comparing dexmedetomidine to other sedatives for mechanically ventilated adults in the ICU. We conducted meta-analyses using random-effects models. The results were reported as relative risks (RRs) for binary outcomes and mean differences (MDs) for continuous outcomes, with corresponding 95% confidence intervals (CIs). In total, 77 randomized trials (n = 11,997) were included. Compared to other sedatives, dexmedetomidine reduced the risk of delirium (RR 0.67, 95% CI 0.55 to 0.81; moderate certainty), the duration of mechanical ventilation (MD - 1.8 h, 95% CI - 2.89 to - 0.71; low certainty), and ICU length of stay (MD - 0.32 days, 95% CI - 0.42 to - 0.22; low certainty). Dexmedetomidine use increased the risk of bradycardia (RR 2.39, 95% CI 1.82 to 3.13; moderate certainty) and hypotension (RR 1.32, 95% CI 1.07 to 1.63; low certainty). In mechanically ventilated adults, the use of dexmedetomidine compared to other sedatives, resulted in a lower risk of delirium, and a modest reduction in duration of mechanical ventilation and ICU stay, but increased the risks of bradycardia and hypotension.
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Affiliation(s)
- Kimberley Lewis
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Alain, United Arab Emirates
| | - Kallirroi Laiya Carayannopoulos
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada
| | - Anders Granholm
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Joshua Piticaru
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada
| | - Zainab Al Duhailib
- Department of Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Dipayan Chaudhuri
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Laura Spatafora
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada
| | - Yuhong Yuan
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Canada
| | - John Centofanti
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada.,Department of Anesthesia, McMaster University, Hamilton, Canada
| | - Jessica Spence
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Anesthesia, McMaster University, Hamilton, Canada.,Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Bram Rochwerg
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Dan Perri
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada.,Division of Clinical Pharmacology and Toxicology, McMaster University, Hamilton, Canada
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, USA.,Armstrong Institute for Patient Safety and Quality, John Hopkins University, Baltimore, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Anne Holbrook
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Division of Clinical Pharmacology and Toxicology, McMaster University, Hamilton, Canada
| | - John W Devlin
- School of Pharmacy, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Northeastern University, Boston, MA, USA
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Kimia Honarmand
- Division of Critical Care Medicine, Department of Medicine, Western University, London, Canada
| | - Begüm Ergan
- Department of Pulmonary and Critical Care, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Eugenia Khorochkov
- Department of Medical Imaging, Memorial University of Newfoundland, St. John's, Canada
| | - Pratik Pandharipande
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA
| | - Mohammed Alshahrani
- Department of Emergency and Critical Care, College of Medicine, Imam Abdulrahman Ben Faisal University, Al Khobar, Kingdom of Saudi Arabia
| | - Tim Karachi
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada
| | - Mark Soth
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada
| | - Yahya Shehabi
- Department of Intensive Care, Monash Health School of Clinical Sciences, The School of Clinical Medicine, University of New South Wales, Clayton, VIC 3168, Randwick, 2031, Australia
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Waleed Alhazzani
- Division of Critical Care, Intensive Care Unit, Department of Medicine, McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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15
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Lawson TN, Balas MC, McNett M. A Scoping Review of the Incidence, Predictors, and Outcomes of Delirium Among Critically Ill Stroke Patients. J Neurosci Nurs 2022; 54:116-123. [PMID: 35532330 DOI: 10.1097/jnn.0000000000000642] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT BACKGROUND: Delirium is a common, often iatrogenically induced syndrome that may impede the physical, cognitive, and psychological recovery of critically ill adults. The effect delirium has on outcomes of intensive care unit patients having acute neurologic injury remains unclear because previous studies frequently exclude this vulnerable population. The aim of this scoping review was to describe the incidence, predictors, and outcomes of delirium among adults admitted to an intensive care unit experiencing an acute ischemic stroke, intracerebral hemorrhage, or aneurysmal subarachnoid hemorrhage. METHODS: PubMed, CINAHL, Web of Science, EMBASE, and Scopus were searched with the terms (1) stroke, (2) critical care, and (3) delirium. Inclusion criteria were original peer-reviewed research reporting the incidence, outcomes, or predictors of delirium after acute stroke among critically ill adults. Editorials, reviews, posters, conference proceedings, abstracts, and studies in which stroke was not the primary reason for admission were excluded. Title and abstract screening, full-text review, and data extraction were performed by 2 authors, with disagreements adjudicated by a third author. RESULTS: The initial search yielded 1051 results. Eighteen studies met eligibility criteria and were included in the review. Stroke type was not mutually exclusive and included persons given a diagnosis of acute ischemic stroke (11), intracerebral hemorrhage (12), aneurysmal subarachnoid hemorrhage (8), and other (1) strokes. Incidence of delirium among stroke patients ranged from 12% to 75%. Predictors of delirium included older age, preexisting dementia, higher severity of illness, and physical restraint use. Outcomes associated with delirium included higher mortality, longer length of stay, worse cognition and quality of life, and lower functional status. CONCLUSIONS: Current findings are limited by heterogenous populations, assessments, and measurement parameters. Detection and management of delirium among critically ill stroke patients requires an approach with specific considerations to the complexities of acute neurological injury and concomitant critical illness.
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16
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Ho MH, Chang HCR, Liu MF, Chen KH, Shen Hsiao ST, Traynor V. Recognizing Intensive Care Unit Delirium: Are Critical Care Nurses Ready? J Nurs Res 2022; 30:e214. [PMID: 35446275 DOI: 10.1097/jnr.0000000000000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Delirium remains significantly undetected in the intensive care unit (ICU). Little is known regarding the level of delirium care knowledge among critical care nurses in Taiwan. PURPOSE This study was designed to investigate the level of knowledge about delirium care among critical care nurses using a multiple-choice question quiz. METHODS A descriptive, cross-sectional approach was used, and data were collected using a web-based survey. The demographic characteristics including age, years worked as critical care nurse, gender, advanced ICU training, educational level, and type of ICU, along with a delirium care knowledge quiz, were collected. The quiz consisted of 16 items measuring (a) symptoms, types, and outcomes; (b) high-risk groups; (c) predisposing and precipitating factors; and (d) assessment and detection of delirium. Data were collected between October 6 and November 16, 2020. RESULTS In total, 324 critical care nurses completed the survey. The rate of correct response on the delirium care quiz for each domain was measured: (a) symptoms, types, and outcomes: 67.1%; (b) high-risk groups: 76.2%; (c) predisposing and precipitating factors: 78.9%; and (d) assessment and detection: 41.5%. The item with the lowest correct response rate was related to the interpretation of delirium assessments. CONCLUSION/IMPLICATIONS FOR PRACTICE The findings of this study suggest that future studies and education should focus on the use and interpretation of the assessment using a valid delirium assessment tool to improve the ability of critical care nurses to detect delirium in ICU settings.
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Affiliation(s)
- Mu-Hsing Ho
- PhD, RN, Research Assistant Professor, School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Hui-Chen Rita Chang
- PhD, RN, Senior Lecturer, School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia
| | - Megan F Liu
- PhD, RN, Associate Professor, School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taiwan
| | - Kee-Hsin Chen
- PhD, RN, Associate Professor, Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University; and Chief Executive Officer, Cochrane Taiwan, Taipei Medical University
| | - Shu-Tai Shen Hsiao
- MSN, RN, Doctoral Candidate, Department of Nursing, Taipei Medical University Hospital; and Clinical Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan
| | - Victoria Traynor
- PhD, RN, Professor, School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia
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17
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Najafi Ghezeljeh T, Rahnamaei F, Omrani S, Haghani S. The effects of interactive E-learning on delirium recognition ability and delirium-related strain of care among critical care nurses. J Intensive Care Soc 2022; 23:44-52. [PMID: 37593534 PMCID: PMC10427842 DOI: 10.1177/1751143720972627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Background Nursing care for patients with delirium is very complex and stressful and is associated with considerable care strain for nurses. Delirium recognition is the first step to the prevention and management of delirium and reduction of strain of care. Education is one of the strategies for improving nurses' delirium recognition ability. Objectives This study aimed to evaluate the effects of interactive E-learning on delirium recognition ability and delirium-related strain of care among critical care nurses. Methods This quasi-experimental study was conducted in 2019 using a two-group pretest-posttest design. Participants were 98 critical care nurses recruited through a census from two hospitals in Iran. They were non-randomly allocated to an intervention and a control group. Study intervention was an interactive E-learning program with four parts on delirium, its prevention, its treatment, and its diagnostic and screening procedures. The program was uploaded on a website and its link was provided to participants in the intervention group. Before and two months after the intervention, data were collected using the Strain of Care for Delirium Index and five case vignettes. For data analysis, the Chi-square, Fisher's exact, independent-sample t, and paired-sample t tests were performed usingthe SPSS software (v. 16.0). Findings Groups did not significantly differ from each other regarding the pretest mean scores of delirium recognition ability and strain of care. After the intervention, the mean score of delirium recognition ability in the intervention group was significantly greater and the mean score of strain of care was significantly lower than the control group (P < 0.05). Conclusion Interactive E-learning is effective in significantly improving critical care nurses' delirium recognition ability and reducing their strain of care. As nurses' heavy workload and limited free time are among the main barriers to their participation in face-to-face educational programs, interactive E-learning can be used for in-service education.
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Affiliation(s)
- Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rahnamaei
- Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Soghra Omrani
- Distance Education Planning, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Haghani
- Statistic and Mathematics Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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18
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Demirer Aydemir F, Oncu S, Yakar NM, Utkugun GA, Gokmen N, Comert B, Ucku R, Gelal A. Potentially inappropriate medication use in elderly patients treated in intensive care units: A cross-sectional study using 2019 Beers, STOPP/v2 Criteria and EU(7)-PIM List. Int J Clin Pract 2021; 75:e14802. [PMID: 34482620 DOI: 10.1111/ijcp.14802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/03/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine the prevalence of and the risk factors for Potentially Inappropriate Medication (PIM), the drug groups most commonly evaluated as PIMs in elderly patients in the ICUs by using 2019 Beers Criteria, STOPP version 2 (v2) Criteria and EU(7)-PIM List. The relation between mortality rate and length of ICU stay with PIMs was also examined. METHODS This was a cross sectional study conducted on patients aged ≥65 years, treated in ICUs (n = 139) between June 8, 2020, and January 11, 2021. Patients' demographic characteristics, clinical data and laboratory findings about the drugs used were collected prospectively. PIMs were evaluated according to each of the criteria applied. Relationship of dependent and independent variables was evaluated using chi-square analysis, t-test and logistic regression analysis. P < .05 was considered statistically significant. RESULTS The number of patients with at least 1 PIM according to three criteria was 118 (84.9%) (80.6%, 59.7%, 48.2%, Beers, STOPP/v2 and EU(7)-PIM List, respectively). In the univariate analysis, receiving renal replacement therapy and high number of drugs were the covariates that significantly affected the presence of PIM according to all three criteria (P < .05). Combined use of anxiolytics and opioids in Beers Criteria (58.3%), antipsychotics (26.6%) in STOPP/v2 Criteria, and antiarrhythmics (23.7%) in EU(7)-PIM List were the drugs that caused PIM at most. No relationship was found between the presence of PIM and mortality. The length of ICU stay was determined significantly longer in the presence of PIM according to Beers Criteria (P = .028). CONCLUSIONS In this study, the prevalence of PIM was determined higher in elderly patients in ICU. Our results supported that 2019 Beers Criteria for ICU patients seems to be more directive in detecting PIMs and determining the prognosis. Reducing the number of drugs administered may be the first step to decrease PIMs in elderly patients in ICU and to maintain the treatment safely.
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Affiliation(s)
- Ferhan Demirer Aydemir
- Division of Intensive Care Medicine, Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Seyma Oncu
- Department of Pharmacology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Nuri M Yakar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Gokalp A Utkugun
- Department of Pharmacology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Necati Gokmen
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Bilgin Comert
- Division of Intensive Care Medicine, Department of Internal Medicine, Izmir Medicana International Hospital, Izmir, Turkey
| | - Reyhan Ucku
- Department of Public Health, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ayse Gelal
- Department of Pharmacology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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19
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Flim M, Hofhuis J, Spronk P, Jaarsma T. Measuring thirst distress of patients in the intensive care unit. Nurs Crit Care 2021; 27:576-582. [PMID: 34612559 DOI: 10.1111/nicc.12719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 08/17/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Thirst is one of the most intense and distressing symptoms experienced by patients in the intensive care unit (ICU), and no validated measurement tools exist. Validating a thirst measurement tool for the ICU population could be a first step in gaining a better understanding of thirst in ICU patients and aid the development and implementation of strategies regarding the prevention and control of thirst. AIM The objective of this study was to determine the validity and reliability of the "Thirst distress scale for patients with heart failure (TDS-HF)" in measuring thirst distress in adult ICU patients. METHODS Content validity was established by an expert panel consisting of ICU nurses, intensivists and five ICU patients. Concurrent validity, known-groups validity and internal consistency were determined in a consecutive sample of 56 awake and oriented ICU patients with a median age of 70 years (IQR: 57-74). RESULTS Content validity of the TDS-HF in the ICU population was low, with item-content validity indexes between 0.25 and 0.75. Concurrent validity was high as Spearman's correlation between TDS-HF and the numeric rating score (0-10) for thirst distress was 0.71. Internal consistency was high (Cronbach's alpha 0.78). When comparing groups, only higher blood urea nitrogen was significantly related to higher scores on the TDS-HF (P = .003). CONCLUSION The TDS-HF has high concurrent validity and reliability in measuring thirst distress in ICU patients. Nevertheless, questions remain regarding the applicability and content validity of the scale, which should be further explored before the TDS-HF can be used in the ICU. RELEVANCE FOR CLINICAL PRACTICE The TDS-HF can be used to explore thirst distress and to evaluate interventions. Individual items of the scale can be used to explore the nature of thirst distress in individual patients.
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Affiliation(s)
- Marleen Flim
- Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands.,Expertise center for Intensive care Rehabilitation Apeldoorn, Apeldoorn, The Netherlands
| | - José Hofhuis
- Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands.,Expertise center for Intensive care Rehabilitation Apeldoorn, Apeldoorn, The Netherlands
| | - Peter Spronk
- Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands.,Expertise center for Intensive care Rehabilitation Apeldoorn, Apeldoorn, The Netherlands
| | - Tiny Jaarsma
- Utrecht University, Utrecht, The Netherlands.,Clinical Health Sciences, Nursing Sciences, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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20
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Ho MH, (Rita) Chang HC, Chen KH, Traynor V. INDICATION for critical care nurses: Protocol for a quasi-experimental study testing the effects of a multi-modal education intervention for delirium care. Collegian 2021. [DOI: 10.1016/j.colegn.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Kooken RWJ, van den Berg M, Slooter AJC, Pop-Purceleanu M, van den Boogaard M. Factors associated with a persistent delirium in the intensive care unit: A retrospective cohort study. J Crit Care 2021; 66:132-137. [PMID: 34547553 DOI: 10.1016/j.jcrc.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/29/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore differences between ICU patients with persistent delirium (PD), non-persistent delirium (NPD) and no delirium (ND), and to determine factors associated with PD. MATERIALS AND METHODS Retrospective cohort study including all ICU adults admitted for ≥12 h (January 2015-February 2020), assessable for delirium and followed during their entire hospitalization. PD was defined as ≥14 days of delirium. Factors associated with PD were determined using multivariable logistic regression analysis. RESULTS Out of 10,295 patients, 3138 (30.5%) had delirium, and 284 (2.8%) had PD. As compared to NPD (n = 2854, 27.7%) and ND (n = 7157, 69.5%), PD patients were older, sicker, more physically restrained, longer comatose and mechanically ventilated, had a longer ICU and hospital stay, more ICU readmissions and a higher mortality rate. Factors associated with PD were age (adjusted odds ratio [aOR] 1.03; 95% confidence interval [CI] 1.02-1.04); emergency surgical (aOR 1.84; 95%CI 1.26-2.68) and medical (aOR 1.57; 95%CI 1.12-2.21) referral, mean Sequential Organ Failure Assessment (SOFA) score before delirium onset (aOR 1.18; 95%CI 1.13-1.24) and use of physical restraints (aOR 5.02; 95%CI 3.09-8.15). CONCLUSIONS Patients with persistent delirium differ in several characteristics and had worse short-term outcomes. Physical restraints were the most strongly associated with PD.
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Affiliation(s)
- Rens W J Kooken
- Department of Intensive Care, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maarten van den Berg
- Department of Intensive Care, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arjen J C Slooter
- Department of Intensive Care and UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| | - Monica Pop-Purceleanu
- Department of Psychiatry, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, the Netherlands.
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22
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Velásquez-Tirado JD, Trzepacz PT, Franco JG. Etiologies of Delirium in Consecutive COVID-19 Inpatients and the Relationship Between Severity of Delirium and COVID-19 in a Prospective Study With Follow-Up. J Neuropsychiatry Clin Neurosci 2021; 33:210-218. [PMID: 33843248 DOI: 10.1176/appi.neuropsych.20100251] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The investigators aimed to describe delirium etiologies and clinical characteristics, as well as the relationship between COVID-19 and delirium severities, at baseline and follow-up after delirium improvement among patients with SARS-CoV-2 infection. METHODS A longitudinal study of 20 consecutive critically ill, delirious COVID-19 inpatients, assessed with the Charlson Comorbidity Index-Short Form (CCI-SF), COVID-19 Clinical Severity Scale (CCSS), Delirium Etiology Checklist, Delirium Motor Subtype Scale-4, and Delirium Diagnostic Tool-Provisional (DDT-Pro), was conducted. Correlational analysis of delirium severity (DDT-Pro) with each measure of clinical severity (CCI-SF and CCSS) and comparison of baseline DDT-Pro scores between patients who were living and those who were deceased at follow-up were conducted. RESULTS Participants were 50-90 years old (male, 75%; hypertension, 60%). The prevalence of preexisting medical comorbidities (CCI-SF) was low and not correlated with delirium severity (p=0.193). Eighteen patients were on mechanical or high-flow noninvasive ventilation at baseline in the intensive care unit (ICU; CCSS scores 2-4). Delirium severity (DDT-Pro scores 0-6) correlated with COVID-19 severity (0.459, p=0.021). Delirium motor subtype was hyperactive in 75% of patients. There were three to four etiologies for delirium in each patient, most commonly organ insufficiency (100%), systemic infection (100%), and metabolic and endocrine disturbances (95%). The baseline DDT-Pro score was ≤4 for five (25%) patients who died before the final assessment, with a trend of being lower than that for survivors (χ2=3.398, p=0.065). CONCLUSIONS Among inpatients with COVID-19, at least three different etiological categories were identified for delirium. ICU staff treating patients with severe cases of COVID-19 should anticipate a greater severity of delirium. Although multivariate analyses with larger study samples are needed, more severe delirium may herald greater risk of death among COVID-19 patients.
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Affiliation(s)
- Juan D Velásquez-Tirado
- Grupo de Investigación en Psiquiatría de Enlace, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (Velásquez-Tirado, Franco); Clinica Universitaria Bolivariana, Medellín, Colombia (Velásquez-Tirado); and the Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Trzepacz)
| | - Paula T Trzepacz
- Grupo de Investigación en Psiquiatría de Enlace, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (Velásquez-Tirado, Franco); Clinica Universitaria Bolivariana, Medellín, Colombia (Velásquez-Tirado); and the Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Trzepacz)
| | - José G Franco
- Grupo de Investigación en Psiquiatría de Enlace, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (Velásquez-Tirado, Franco); Clinica Universitaria Bolivariana, Medellín, Colombia (Velásquez-Tirado); and the Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Trzepacz)
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23
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Kotfis K, Witkiewicz W, Szylińska A, Witkiewicz K, Nalewajska M, Feret W, Wojczyński Ł, Duda Ł, Ely EW. Delirium Severely Worsens Outcome in Patients with COVID-19-A Retrospective Cohort Study from Temporary Critical Care Hospitals. J Clin Med 2021; 10:2974. [PMID: 34279458 PMCID: PMC8267650 DOI: 10.3390/jcm10132974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 01/10/2023] Open
Abstract
Delirium is a sign of deterioration of homeostasis and worse prognosis. The aim of this study was to investigate the frequency, risk factors and prognosis of delirium in patients with COVID-19 in a temporary acute setting hospital. A retrospective cohort analysis of data collected between October 2020 and February 2021 from two temporary acute care hospitals was performed. All consecutive hospitalized patients ≥18 years old with COVID-19 were included. An assessment of consciousness was carried out at least two times a day, including neurological examination. Delirium was identified through retrospective chart review according to DSM-5 criteria if present at least once during hospitalization. Analysis included 201 patients, 39 diagnosed with delirium (19.4%). Delirious patients were older (p < 0.001), frailer (p < 0.001) and the majority were male (p = 0.002). Respiratory parameters were worse in this group with higher oxygen flow (p = 0.013), lower PaO2 (p = 0.043) and higher FiO2 (p = 0.006). The mortality rate was significantly higher in patients with delirium (46.15% vs 3.70%, p < 0.001) with OR 17.212 (p < 0.001) corrected for age and gender. Delirious patients experienced significantly more complications: cardiovascular (OR 7.72, p < 0.001), pulmonary (OR 8.79, p < 0.001) or septic (OR 3.99, p = 0.029). The odds of mortality in patients with COVID-19 presenting with delirium at any point of hospitalization were seventeen times higher.
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Affiliation(s)
- Katarzyna Kotfis
- Department Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Wojciech Witkiewicz
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (W.W.); (Ł.D.)
| | - Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland;
| | - Karina Witkiewicz
- Department of Pulmonology, Pomeranian Medical University, 70-891 Szczecin, Poland;
| | - Magdalena Nalewajska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.N.); (W.F.); (Ł.W.)
| | - Wiktoria Feret
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.N.); (W.F.); (Ł.W.)
| | - Łukasz Wojczyński
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.N.); (W.F.); (Ł.W.)
| | - Łukasz Duda
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (W.W.); (Ł.D.)
| | - Eugene Wesley Ely
- Critical Illness Brain Dysfunction Survivorship Center, Nashville, Vanderbilt University Medical Center, Nashville, TN 37203, USA;
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care System, Nashville, TN 37212, USA
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24
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Ho MH, Yu LF, Lin PH, Chang HCR, Traynor V, Huang WC, Montayre J, Chen KH. Effects of a simulation-based education programme on delirium care for critical care nurses: A randomized controlled trial. J Adv Nurs 2021; 77:3483-3493. [PMID: 34155687 DOI: 10.1111/jan.14938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/01/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022]
Abstract
AIMS To evaluate the effects of a simulation-based education programme on critical care nurses' knowledge, confidence, competence and clinical performance in providing delirium care. DESIGN Single-blinded randomized controlled trial. METHODS Registered nurses who work in intensive care units were recruited from a university-affiliated acute major metropolitan teaching hospital. The intervention group received: (i) five online-learning delirium care videos, (ii) one face-to-face delirium care education session and (iii) a simulation-based education programme with a role-play scenario-based initiative and an objective structured clinical examination. The control group received only online videos which were the same as those provided to the intervention group. Delirium care knowledge, confidence, competence, and clinical performance as outcomes were collected at: baseline, immediately after intervention, and within 6 weeks post-intervention to test whether there were any changes and if they were sustained over time. Data were collected between 2 October and 29 December 2020. The repeated-measures analysis of variance was used to examine for changes in delirium care knowledge, confidence, and competence within groups. RESULTS Seventy-two critical care nurses participated with 36 each allocated to the intervention group and control group. No statistically significant difference was observed between the two groups in outcome variables at 6 weeks post-intervention. In the intervention group, significant within-group changes were observed in terms of delirium care knowledge, confidence, and competence over time. By contrast, no significant changes were observed in outcome measures over time in the control group. CONCLUSION The simulation-based education programme is an effective and feasible strategy to improve delirium care by enhancing the knowledge, confidence, competence and clinical performance of critical care nurses. IMPACT Our findings provide evidence regarding the development and implementation of a simulation-based education programme in hospitals for health professional education in Taiwan.
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Affiliation(s)
- Mu-Hsing Ho
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, New South Wales, Australia.,Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Lee-Fen Yu
- Center for Nursing and Healthcare Research in Clinical Practice Application, Taipei Municipal Wanfang Hospital-Taipei Medical University, Taipei, Taiwan
| | - Pu-Hung Lin
- Department of Nursing, Taipei Municipal Wanfang Hospital-Taipei Medical University, Taipei, Taiwan
| | - Hui-Chen Rita Chang
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, New South Wales, Australia
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, New South Wales, Australia
| | - Wen-Cheng Huang
- Department of Emergency, Taipei Municipal Wanfang Hospital-Taipei Medical University, Taipei, Taiwan
| | - Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Kee-Hsin Chen
- Center for Nursing and Healthcare Research in Clinical Practice Application, Taipei Municipal Wanfang Hospital-Taipei Medical University, Taipei, Taiwan.,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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25
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Abstract
Delirium, a form of acute brain dysfunction, is very common in the critically ill adult patient population. Although its pathophysiology is poorly understood, multiple factors associated with delirium have been identified, many of which are coincident with critical illness. To date, no drug or non-drug treatments have been shown to improve outcomes in patients with delirium. Clinical trials have provided a limited understanding of the contributions of multiple triggers and processes of intensive care unit (ICU) acquired delirium, making identification of therapies difficult. Delirium is independently associated with poor long term outcomes, including persistent cognitive impairment. A longer duration of delirium is associated with worse long term cognition after adjustment for age, education, pre-existing cognitive function, severity of illness, and exposure to sedatives. Interestingly, differences in prevalence are seen between ICU survivor populations, with survivors of acute respiratory distress syndrome experiencing higher rates of cognitive impairment at early follow-up compared with mixed ICU survivor populations. Although cognitive performance improves over time for some ICU survivors, impairment is persistent in others. Studies have so far been unable to identify patients at higher risk of long term cognitive impairment; this is an active area of scientific investigation.
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Affiliation(s)
- M Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Timothy D Girard
- Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA
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26
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van den Boogaard M, Zegers M. Delirium in ICU patients with COVID-19. Any difference? Intensive Crit Care Nurs 2021; 64:103029. [PMID: 33678515 DOI: 10.1016/j.iccn.2021.103029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mark van den Boogaard
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Intensive Care Medicine, Nijmegen, the Netherlands; Geert Grooteplein Zuid 10, (internal post 710) 6525GA, Nijmegen, the Netherlands.
| | - Marieke Zegers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Intensive Care Medicine, Nijmegen, the Netherlands; Geert Grooteplein Zuid 10, (internal post 710) 6525GA, Nijmegen, the Netherlands
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27
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Lambert J, Vermassen J, Fierens J, Peperstraete H, Petrovic M, Colpaert K. Discharge from hospital with newly administered antipsychotics after intensive care unit delirium - Incidence and contributing factors. J Crit Care 2020; 61:162-167. [PMID: 33171333 DOI: 10.1016/j.jcrc.2020.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Delirium in the intensive care unit (ICU) is often treated with haloperidol or atypical antipsychotics. Antipsychotic treatment can lead to severe adverse effects and excess mortality. After initiation in the ICU, patients are at risk of having their antipsychotics continued unnecessarily at ICU and hospital discharge. This study aims to determine the incidence of, and risk factors for antipsychotic continuation at hospital discharge after ICU delirium. METHODS This retrospective observational study was performed in a tertiary care center. Adult patients who received antipsychotics for ICU delirium during 2016 were included. Data was extracted from patient records. After univariate testing, a multivariate binary logistic regression model was used to identify independent risk factors for antipsychotic continuation. RESULTS A total of 196 patients were included, of which 104 (53.1%) and 41 (20.9%) had their antipsychotics continued at ICU and hospital discharge respectively. Medical ICU admission (odds ratio [95% confidence interval] 2.97 [1.37-6.41]) and quetiapine treatment (5.81 [1.63-20.83]) were independently associated with antipsychotic continuation at hospital discharge. CONCLUSIONS Approximately one in five patients were discharged from the hospital with continued antipsychotics. Hospital policies should implement strategies for systematic antipsychotic tapering and better follow-up of antipsychotics at transitions of care.
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Affiliation(s)
- Johannes Lambert
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, B9000 Ghent, Belgium.
| | - Joris Vermassen
- Department of Intensive Care, Ghent University Hospital, Corneel Heymanslaan 10, B9000 Ghent, Belgium
| | - Jan Fierens
- Department of Intensive Care, Ghent University Hospital, Corneel Heymanslaan 10, B9000 Ghent, Belgium
| | - Harlinde Peperstraete
- Department of Intensive Care, Ghent University Hospital, Corneel Heymanslaan 10, B9000 Ghent, Belgium
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Corneel Heymanslaan 10, B9000 Ghent, Belgium
| | - Kirsten Colpaert
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, B9000 Ghent, Belgium; Department of Intensive Care, Ghent University Hospital, Corneel Heymanslaan 10, B9000 Ghent, Belgium
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28
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Mansutti I, Saiani L, Morandini M, Palese A. Post-stroke delirium risk factors, signs and symptoms of onset and outcomes as perceived by expert nurses: A focus group study. J Stroke Cerebrovasc Dis 2020; 29:105013. [PMID: 32807428 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/19/2020] [Accepted: 05/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Higher rates of delirium have been reported among patients with acute stroke. However, poorly modifiable risk factors have been documented to date while sign and symptoms capable of early detecting its onset and outcomes in this specific population have been largely neglected. The aim of this study was to emerge nurses' clinical knowledge and experiences regarding post-stroke delirium (a) risk factors, (b) signs and symptoms of delirium onset, and (c) outcomes. METHOD A qualitative study based upon focus groups have been performed on 2019 and here reported according to the COnsolidated criteria for REporting Qualitative research. A purposeful sample of 28 nurses was invited to participate in focus groups at two Italian hospitals, and 20 participated. A semi-structured question guide was developed; all focus groups were audio recorded and then transcribed verbatim. Two researchers independently analysed, coded and categorised the findings according to the main research question. A member checking with ten nurses was also performed to ensure rigour. RESULTS Four risk factors emerged (a) at the individual level; (b) associated with previous (e.g., dementia) and the current clinical condition (stroke), (c) associated with the nursing care delivered, and (d) associated with the hospital environment. In their daily practice, nurses suspect the onset of delirium when some motor, verbal or multidimensional signs and symptoms occur. The delirium episodes affect outcomes at the individual, family, and at the system levels. CONCLUSIONS In a field of research in need of study, we have involved expert nurses who shared their tacit knowledge to gain insights regarding risk factors, early signs and symptoms of delirium and its outcomes to address future directions of this research field.
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Affiliation(s)
- Irene Mansutti
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.
| | - Luisa Saiani
- Department of Diagnostics and Public Health, University of Verona, Italy.
| | - Marzia Morandini
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy.
| | - Alvisa Palese
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy.
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29
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Ho MH, Chen KH, Montayre J, Liu MF, Chang CC, Traynor V, Shen Hsiao ST, Chang HC(R, Chiu HY. Diagnostic test accuracy meta-analysis of PRE-DELIRIC (PREdiction of DELIRium in ICu patients): A delirium prediction model in intensive care practice. Intensive Crit Care Nurs 2020; 57:102784. [DOI: 10.1016/j.iccn.2019.102784] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/09/2019] [Accepted: 12/04/2019] [Indexed: 11/27/2022]
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30
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Abstract
PURPOSE OF REVIEW The alteration of circadian rhythms in the postoperative period has been demonstrated to influence the outcomes. With this narrative review we would revise how anesthesia, surgery and intensive care can interfere with the circadian clock, how this could impact on the postsurgical period and how to limit the disruption of the internal clock. RECENT FINDINGS Anesthesia affects the clock in relation to the day-time administration and the type of anesthetics, N-methyl-D-aspartate receptor antagonists or gamma-aminobutyric acid receptors agonists. Surgery causes stress and trauma with consequent alteration in the circadian release of cortisol, cytokines and melatonin. ICU represents a further challenge for the patient internal clock because of sedation, immobility, mechanical ventilation and alarms noise. SUMMARY The synergic effect of anesthesia, surgery and postoperative intensive care on circadian rhythms require a careful approach to the patient considering a role for therapies and interventions aimed to re-establish the normal circadian rhythms. Over time, approach like the Awakening and Breathing Coordination, Delirium Monitoring and Management, Early Mobility and Family engagement and empowerment bundle can implement the clinical practice.
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31
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van den Boogaard M, Tilburgs B. Can we accurately predict ICU delirium? Intensive Crit Care Nurs 2020; 57:102809. [PMID: 32029381 DOI: 10.1016/j.iccn.2020.102809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Health Science, Geert Grooteplein Zuid 10, (Internal Post 710) 6525GA, Nijmegen, the Netherlands.
| | - Bram Tilburgs
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Health Science, Geert Grooteplein Zuid 10, (Internal Post 710) 6525GA, Nijmegen, the Netherlands
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32
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Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium: Results of the REDUCE Study. Anesthesiology 2019; 131:328-335. [PMID: 31246603 DOI: 10.1097/aln.0000000000002812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Delirium incidence in intensive care unit patients is high and associated with impaired long-term outcomes. The use of prophylactic haloperidol did not improve short-term outcome among critically ill adults at high risk of delirium. This study evaluated the effects of prophylactic haloperidol use on long-term quality of life in this group of patients and explored which factors are associated with change in quality of life. METHODS A preplanned secondary analysis of long-term outcomes of the pRophylactic haloperidol usE for DeliriUm in iCu patients at high risk for dElirium (REDUCE) study was conducted. In this multicenter randomized clinical trial, nondelirious intensive care unit patients were assigned to prophylactic haloperidol (1 or 2 mg) or placebo (0.9% sodium chloride). In all groups, patients finally received study medication for median duration of 3 days [interquartile range, 2 to 6] until onset of delirium or until intensive care unit discharge. Long-term outcomes were assessed using the Short Form-12 questionnaire at intensive care unit admission (baseline) and after 1 and 6 months. Quality of life was summarized in the physical component summary and mental component summary scores. Differences between the haloperidol and placebo group and factors associated with changes in quality of life were analyzed. RESULTS Of 1,789 study patients, 1,245 intensive care unit patients were approached, of which 887 (71%) responded. Long-term quality of life did not differ between the haloperidol and placebo group (physical component summary mean score of 39 ± 11 and 39 ± 11, respectively, and P = 0.350; and mental component summary score of 50 ± 10 and 51 ± 10, respectively, and P = 0.678). Age, medical and trauma admission, quality of life score at baseline, risk for delirium (PRE-DELIRIC) score, and the number of sedation-induced coma days were significantly associated with a decline in long-term quality of life. CONCLUSIONS Prophylactic haloperidol use does not affect long-term quality of life in critically ill patients at high risk for delirium. Several factors, including the modifiable factor number of sedation-induced coma days, are associated with decline in long-term outcomes.
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van den Boogaard M, Slooter AJC. Delirium in critically ill patients: current knowledge and future perspectives. BJA Educ 2019; 19:398-404. [PMID: 33456864 DOI: 10.1016/j.bjae.2019.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
| | - A J C Slooter
- University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
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Ramelet AS, Aitken LM. Patient comfort during critical illness special issue. Aust Crit Care 2019; 31:143-144. [PMID: 29729714 DOI: 10.1016/s1036-7314(18)30076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Papastavrou E, Papaioannou M, Evripidou M, Tsangari H, Kouta C, Merkouris A. Development of a Tool for the Assessment of Nurses' Attitudes Toward Delirium. J Nurs Meas 2019; 27:277-296. [PMID: 31511410 DOI: 10.1891/1061-3749.27.2.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The prevalence of delirium during hospitalization is high in older patients and there is evidence of staff regarding them as unpopular or a burden. This study aims to develop an instrument examining nurses' attitudes toward patients with delirium. METHODS Stages included (a) content identification, (b) content development, (c) content critique, (e) pilot study with a test-retest reliability, (f) field study consisting of psychometric testing of the internal consistency and construct validity. RESULTS The Cronbach's alpha was 0.89 and the stability reliability was acceptable. The factor analysis resulted in three factors explaining a total of 56.5% of the variance. hese factors are "beliefs," "behavior," and "emotions," explaining 37.025%, 12.792%, and 5.652% of variance. CONCLUSIONS The Attitude Tool of Delirium (ATOD) is a reliable and valid instrument for the assessment of attitudes toward delirium.
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Rood PJT, van de Schoor F, van Tertholen K, Pickkers P, van den Boogaard M. Differences in 90-day mortality of delirium subtypes in the intensive care unit: A retrospective cohort study. J Crit Care 2019; 53:120-124. [PMID: 31228762 DOI: 10.1016/j.jcrc.2019.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Many intensive care unit (ICU) patients suffer from delirium which is associated with deleterious short-term and long-term effects, including mortality. We determined the association between different delirium subtypes and 90-day mortality. MATERIALS AND METHODS Retrospective cohort study in ICU patients admitted in 2015-2017. Delirium, including its subtypes, was determined using the confusion assessment method-ICU (CAM-ICU) and Richmond agitation sedation scale (RASS). Exclusion criteria were insufficient assessments and persistent coma. Cox-regression analysis was used to determine associations of delirium subtypes with 90-day mortality, including relevant covariates (APACHE-IV, length of ICU stay and mechanical ventilation). RESULTS 7362 ICU patients were eligible of whom 6323 (86%) were included. Delirium occurred in 1600 (25%) patients (stratified for delirium subtype: N = 571-36% mixed, N = 485-30% rapidly reversible, N = 433-27% hypoactive, N = 111-7% hyperactive). The crude hazard ratio (HR) for overall prevalent delirium with 90-day mortality was 2.84 (95%CI: 2.32-3.49), and the adjusted HR 1.29 (95%CI: 1.01-1.65). The adjusted HR for 90-day mortality was 1.57 (95%CI: 1.51-2.14) for the mixed subtype, 1.40 (95%CI: 0.71-2.73) for hyperactive, 1.31 (95%CI: 0.93-1.84) for hypoactive and 0.95 (95%CI: 0.64-1.42) for rapidly reversible delirium. CONCLUSION After adjusting for covariates, including competing risk factors, only the mixed delirium subtype was significantly associated with 90-day mortality.
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Affiliation(s)
- Paul J T Rood
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute of Health Sciences, Radboud university medical center, Nijmegen, the Netherlands.
| | - Freek van de Schoor
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Koen van Tertholen
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute of Health Sciences, Radboud university medical center, Nijmegen, the Netherlands.
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Smithburger PL, Patel MK. Pharmacologic Considerations Surrounding Sedation, Delirium, and Sleep in Critically Ill Adults: A Narrative Review. J Pharm Pract 2019; 32:271-291. [PMID: 30955461 DOI: 10.1177/0897190019840120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Agitation, delirium, and sleep dysfunction in the intensive care unit (ICU) are common occurrences that result in negative patient outcomes. With the recent publication of the 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PAD-IS), several areas are of particular interest due to emerging literature or conflicting results of research. OBJECTIVE To highlight areas where emerging literature or variable study results exist and to provide the clinician with recommendations regarding patient management. METHODS The 2018 PAD-IS guidelines were reviewed, and areas of emerging literature or lack of consensus of included investigations surrounding pharmacologic management of sedation, delirium, and sleep in the ICU were identified. A review and appraisal of the literature was conducted specifically to address the identified areas. Prospective, randomized trials were included in this narrative review. RESULTS Four areas with emerging data or conflicting evidence were identified and included: use of propofol or dexmedetomidine for sedation, pharmacologic prevention of delirium, treatment of delirium, and pharmacologic strategies to improve sleep. CONCLUSION A comprehensive approach to the prevention and management of delirium, sedation, and sleep in the ICU is necessary to optimize patient outcomes.
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Affiliation(s)
- Pamela L Smithburger
- 1 Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Mona K Patel
- 2 Department of Pharmacy, Surgical Intensive Care Unit, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
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Zayed Y, Barbarawi M, Kheiri B, Banifadel M, Haykal T, Chahine A, Rashdan L, Aburahma A, Bachuwa G, Seedahmed E. Haloperidol for the management of delirium in adult intensive care unit patients: A systematic review and meta-analysis of randomized controlled trials. J Crit Care 2019; 50:280-286. [DOI: 10.1016/j.jcrc.2019.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/10/2018] [Accepted: 01/11/2019] [Indexed: 12/23/2022]
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And the award goes to..... Aust Crit Care 2019. [DOI: 10.1016/s1036-7314(19)30071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Alosaimi FD, Alghamdi A, Alsuhaibani R, Alhammad G, Albatili A, Albatly L, Althomali B, Aljamaan F, Maldonado JR. Validation of the Stanford Proxy Test for Delirium (S-PTD) among critical and noncritical patients. J Psychosom Res 2018; 114:8-14. [PMID: 30314583 DOI: 10.1016/j.jpsychores.2018.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Stanford Proxy Test for Delirium (S-PTD) is a tool developed to be completed by nurses at the end of their shift. It was designed to use the knowledge acquired during a full shift of nurse-patient interaction. The objective of our study was to validate the S-PTD among a mixed sample of patients in both the intensive care unit (ICU) and non-ICU settings. METHODS A cross-sectional study was conducted in an ICU and three general medical wards in a tertiary care hospital. Patients were independently and blindly assessed for delirium by (1) the patients' primary nurses using the S-PTD at the end of their shift, and (2) a Consultation liaison psychiatrist who conducted a neuropsychiatric evaluation based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). RESULTS A total 288 patients were included in current analysis. Using the S-PTD, delirium was identified in 72 (25.0%), while an expert neuropsychiatric examination, based on DSM-5 identified delirium in 75 (26.0%) patients. This study demonstrated that the S-PTD has very strong discriminative ability (area under the curve= 0.946, p<0.001). An S-PTD cut-off score ≥3 was associated with an 82.7% sensitivity, an 95.3% specificity, an 86.1% positive predictive value, a 94.0% negative predictive value, and a 92.0% overall diagnostic accuracy. These results were similar in both ICU and general ward patients. CONCLUSION The S-PTD has excellent sensitivity and specificity in detecting delirium in both ICU and ward patients, even when compared with the gold-standard, a DSM-based neuropsychiatric examination.
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Affiliation(s)
- Fahad D Alosaimi
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia.
| | - Ayedh Alghamdi
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Raya Alsuhaibani
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Ghadah Alhammad
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Amjad Albatili
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Latifah Albatly
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Bandar Althomali
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Fadi Aljamaan
- Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia
| | - José R Maldonado
- Psychosomatic Medicine Service, Departments of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Kang J, Lee M, Ko H, Kim S, Yun S, Jeong Y, Cho Y. Effect of nonpharmacological interventions for the prevention of delirium in the intensive care unit: A systematic review and meta-analysis. J Crit Care 2018; 48:372-384. [PMID: 30300863 DOI: 10.1016/j.jcrc.2018.09.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to classify nonpharmacological interventions used for preventing delirium in the intensive care unit (ICU), and estimate their effect size. MATERIALS AND METHODS In this systematic review and meta-analysis, the literature was searched and studies were selected based on the PRISMA flow chart. Data sources included MEDLINE, Cochrane, CINHAHL, PsyInfo, and EMBASE. We used Cochrane's Effective Practice and Organisation of Care (EPOC) criteria in study design and quality assessment of the meta-analysis. RESULTS This systematic review and meta-analysis included 35 and 15 studies, respectively. Studies were grouped into nine intervention types: multicomponent (16 studies), physical environment (9), daily interruption of sedation (2), exercise (2), patient education (2), automatic warning system (1), cerebral hemodynamics improving (1), family participation (1), and sedation reducing protocol (1). The effect size of preventive nonpharmacological interventions had an odds ratio (OR) of 0.66 (95% confidence interval [CI], 0.50-0.86) for delirium occurrence, and an OR of 0.31 (95% CI, 0.10-0.94) for delirium duration. Although relevant studies by interventions were lacking, a partial subgroup analysis by intervention was performed. CONCLUSIONS Nonpharmacological interventions were effective in reducing the duration and occurrence of delirium. Consistent application and development of nonpharmacological interventions for use in the ICU are important.
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Affiliation(s)
- Jiyeon Kang
- Department of Nursing, Dong-A University, Busan, Republic of Korea
| | - Minju Lee
- Department of Nursing, Dong-A University, Busan, Republic of Korea.
| | - Hyunyoung Ko
- Department of Nursing, Jinju Health College, Jinju, Republic of Korea
| | - Sookyung Kim
- Surgical Intensive Care Unit, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Seonyoung Yun
- Department of Nursing, Youngsan University, Yangsan, Republic of Korea
| | - Yeonjin Jeong
- Department of Nursing, Dong-A University, Busan, Republic of Korea
| | - Youngshin Cho
- Surgical Intensive Care Unit, Kosin University Gospel Hospital, Busan, Republic of Korea
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