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Fuentes AL, Makhija H, Fine JM, Alicea Reyes P, Diaz De Leon B, Sanchez-Azofra A, Rodriguez-Flores L, Weston J, Marquine MJ, Hu E, Espinosa-Meza R, Serafin Higuera IR, Vacas Jacques P, Pollack D, Novelli F, Ely EW, Malhotra A, Needham DM, Martin JL, Kamdar BB, Arroyo-Novoa CM, Figueroa-Ramos MI. Spanish Translation and Cultural Adaptation of the Intensive Care Unit Delirium Playbook. ATS Sch 2024; 5:259-273. [PMID: 38957494 PMCID: PMC11215996 DOI: 10.34197/ats-scholar.2023-0114oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/13/2023] [Indexed: 07/04/2024] Open
Abstract
Background A lack of high-quality provider education hinders the delivery of standard-of-care delirium detection and prevention practices in the intensive care unit (ICU). To fill this gap, we developed and validated an e-learning ICU Delirium Playbook consisting of eight videos and a 44-question knowledge assessment quiz. Given the increasing Spanish-speaking population worldwide, we translated and cross-culturally adapted the playbook from English into Spanish. Objective To translate and culturally adapt the ICU Delirium Playbook into Spanish, the second most common native language worldwide. Methods The translation and cross-cultural adaptation process included double forward and back translations and harmonization by a 14-person interdisciplinary team of ICU nurses and physicians, delirium experts, methodologists, medical interpreters, and bilingual professionals representing many Spanish-speaking global regions. After a preeducation quiz, a nurse focus group completed the playbook videos and posteducation quiz, followed by a semistructured interview. Results The ICU Delirium Playbook: Spanish Version maintained conceptual equivalence to the English version. Focus group participants posted mean (standard deviation) pre- and post-playbook scores of 63% (10%) and 78% (12%), with a 15% (11%) pre-post improvement (P = 0.01). Participants reported improved perceived competency in performing the Confusion Assessment Method for the ICU and provided positive feedback regarding the playbook. Conclusion After translation and cultural adaptation, the ICU Delirium Playbook: Spanish Version yielded significant knowledge assessment improvements and positive feedback. The Spanish playbook is now available for public dissemination.
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Affiliation(s)
| | - Hirsh Makhija
- Division of Pulmonary, Critical Care and Sleep Medicine and
| | | | | | | | | | | | - Julia Weston
- Department of Medicine, University of California, San Diego School of Medicine, La Jolla, California
| | - María J. Marquine
- Division of Geriatrics, Department of Medicine, and
- Department of Psychiatry, Duke University, Durham, North Carolina
| | | | | | | | - Paulino Vacas Jacques
- Departamento de Medicina y Psicología, Universidad Autonoma de Baja California, Baja California, Mexico
| | - Daniel Pollack
- Nursing Education & Development Research Department, and
- Critical Care Unit, University of California, San Diego Health, San Diego, California
| | - Francesca Novelli
- Nursing Education & Development Research Department, and
- Critical Care Unit, University of California, San Diego Health, San Diego, California
- School of Nursing, Oregon Health and Science University, Ashland, Oregon
| | - E. Wesley Ely
- Critical Illness, Brain Dysfunction and Survivorship Center and
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research, Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine and
| | - Dale M. Needham
- Outcomes After Critical Illness and Surgery Group
- Division of Pulmonary & Critical Care Medicine, and
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer L. Martin
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California; and
| | - Biren B. Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine and
- Veterans Affairs San Diego Healthcare, La Jolla, California
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Rivas-Perez H. Lost in Translation: Deliro or Delirum. ATS Sch 2024; 5:221-223. [PMID: 38957491 PMCID: PMC11216300 DOI: 10.34197/ats-scholar.2024-0055ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Affiliation(s)
- Hiram Rivas-Perez
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
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Carboni Bisso I, Ávila Poletti D, Huespe I, Villalba D, Olmos D, Las Heras M, Carini F. Adherencia al paquete de medidas ABCDEF durante la pandemia de COVID-19. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2022. [PMCID: PMC8685181 DOI: 10.1016/j.acci.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introducción El objetivo de este estudio fue describir el conocimiento y el uso reportado del paquete de medidas ABCDEF en las unidades de cuidados intensivos (UCI) de adultos de la República Argentina durante la pandemia por SARS-CoV-2. Métodos Se realizó un estudio cualitativo a través de una encuesta nacional dirigida a profesionales de la salud. Resultados Se recibieron 396 cuestionarios completos de profesionales de 21 provincias argentinas y la Ciudad Autónoma de Buenos Aires. El 66% de los participantes contestaron que conocen el paquete y lo aplican con diferentes grados de implementación. El 42,9% informó que usa al menos una herramienta validada para evaluar el dolor. Más de la mitad de los encuestados afirman realizar vacaciones de sedación y pruebas de ventilación espontánea diariamente. Las escalas de sedación fueron utilizadas por el 66,6% de los participantes en forma rutinaria. El 62% utiliza herramientas validadas para la detección de delirium. Respecto de la movilización temprana y ejercicio de los pacientes, el 91,8% de los profesionales entrevistados comunicaron que realizan rehabilitación neuromuscular en su UCI. Finalmente, solamente el 6,8% informó que su unidad estaba abierta las 24 horas para las visitas familiares. Las principales barreras a la aplicación del paquete de medidas fueron los recursos humanos y hospitalarios limitados, la resistencia al cambio, la falta de información y el aislamiento por COVID-19. Conclusión El 66% de los participantes contestó que conoce el paquete y lo aplica con diferentes grados de implementación.
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The Design and validation of a Nursing Plan for Elderly Patients with Postoperative Delirium. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224504. [PMID: 31731593 PMCID: PMC6888289 DOI: 10.3390/ijerph16224504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022]
Abstract
Delirium is the sudden alteration of the state of consciousness and perception, fluctuating over hours or days. It predominates in older adults and is associated with the aging process. The incidence of delirium increases between 10% and 15% in surgical interventions. The objective of this study was the design and validation of a nursing care plan for elderly patients with postoperative delirium. This study was based on the Delphi method and applied to nursing professionals at the Hospital Universitario del Caribe, Cartagena. The sample consisted of 36 nurses with knowledge of the taxonomy of nursing diagnoses. The care plan was applied in two rounds. For the analysis, measures of central tendency and dispersion were used, as well as frequency and percentages. The participants were women (90.9%) from the hospitalization service (51.5%), with training in Nursing Diagnosis (NANDA), Nursing interventions classification (NIC) and Nursing Outcome Classifications (NOC) (78.8%). The validated care plan has eight diagnostic features. Highlights include “Risk for Ineffective Cerebral Tissue Perfusion” and “Disturbed Sleep Pattern” (in 98.1%; 11 results), with the highest score in the first round being “Vital Signs” (with 100%) and “Sleep” (100%) and “Mobility” (100%) in the second round. Forty-four interventions and 18 suggested activities were identified. This care plan offers the nursing professionals reliable and pertinent tools in clinical practice for the management of patients with postoperative delirium.
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Torres-Contreras CC, Páez-Esteban AN, Hinestrosa-Díaz Del Castillo A, Rincón-Romero MK, Amaris-Vega A, Martínez-Patiño JP. Factors associated with delirium in critical patients in a health institution in Bucaramanga, Colombia. ENFERMERIA INTENSIVA 2018; 30:13-20. [PMID: 29909126 DOI: 10.1016/j.enfi.2018.03.002] [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] [Received: 07/02/2017] [Revised: 02/17/2018] [Accepted: 03/03/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To determine the incidence and the factors associated with delirium in intensive care unit patients. METHODS A cohort study conducted on 134 patients in the intensive care unit at a clinic in Bucaramanga, Colombia., who were recruited in the first 24hours following admission and on whom the Richmond Agitation-Sedation Scale (RASS), PRE-DELIRIC version in Spanish, and Confusion Assessment method for Intensive Care Unit (CAM-ICU) were applied; the outcome was evaluated through daily monitoring with CAM-ICU. RESULTS The incidence of delirium was 20.2%, the predominating type was hypoactive at 66.7%, followed by the hyperactive type at 7.4% and mixed at 25.9%. Fifty-two percent of the patients with delirium died. In the bivariate analysis, the use of sedatives (Relative Risk(RR) 2.4, 95% confidence interval (95% CI) = 1.2-4.5), infection (RR = 2. 8, 95% CI=1.3-5.9), metabolic acidosis (RR = 4 3, 95% CI=2.3-8.0), mechanical ventilation (RR = 4 6, 95% CI=2.0-10.6), aged over 60 years (RR = 2 3, 95% CI=1.09-5.3) and APACHE score greater than 14 (RR = 3. 0) (95% CI=1.1-8.2) were identified as risk factors for delirium. The multivariate analysis only found a relationship with infection (RR = 3 8, 95% CI=1.6-9.1) and being aged over 60 years (RR = 3 2, 95% CI 1.2-8.3). CONCLUSIONS delirium is frequent in patients in the intensive care unit, especially the hypoactive type. Half of the patients with delirium died. The main risk factors for delirium are infection and being over 60 years age, therefore, delirium prevention activities should focus on these critical patients.
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Affiliation(s)
| | - A N Páez-Esteban
- Programa de Enfermería, Universidad de Santander , Bucaramanga, Colombia
| | | | - M K Rincón-Romero
- Programa de Enfermería, Universidad de Santander , Bucaramanga, Colombia
| | - A Amaris-Vega
- Semillero de Investigación CUIDEN, Programa de Enfermería, Universidad de Santander, Bucaramanga, Colombia
| | - J P Martínez-Patiño
- Semillero de Investigación CUIDEN, Programa de Enfermería, Universidad de Santander, Bucaramanga, Colombia
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Mesa P, Previgliano IJ, Altez S, Favretto S, Orellano M, Lecor C, Soca A, Ely EW. Delirium in a Latin American intensive care unit. A prospective cohort study of mechanically ventilated patients. Rev Bras Ter Intensiva 2018; 29:337-345. [PMID: 29044304 PMCID: PMC5632977 DOI: 10.5935/0103-507x.20170058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/03/2017] [Indexed: 11/20/2022] Open
Abstract
Objective To establish the prevalence of delirium in a general
intensive care unit and to identify associated factors, clinical expression
and the influence on outcomes. Methods This was a prospective cohort study in a medical surgical intensive care
unit. The Richmond Agitation-Sedation Scale and Confusion Assessment Method
for the Intensive Care Unit were used daily to identify
delirium in mechanically ventilated patients. Results In this series, delirium prevalence was 80% (N = 184
delirious patients out of 230 patients). The number of patients according to
delirium psychomotor subtypes was as follows: 11
hyperactive patients (6%), 9 hypoactive patients (5%) and 160 mixed patients
(89%). Multiple logistic regression modeling using delirium
as the dependent outcome variable (to study the risk factors for
delirium) revealed that age > 65 years, history of
alcohol consumption, and number of mechanical ventilation days were
independent variables associated with the development of
delirium. The multiple logistic regression model using
hospital mortality as the dependent outcome variable (to study the risk
factors for death) showed that severity of illness, according to the Acute
Physiology and Chronic Health Evaluation II, mechanical ventilation for more
than 7 days, and sedation days were all independent predictors for excess
hospital mortality. Conclusion This Latin American prospective cohort investigation confirmed specific
factors important for the development of delirium and the
outcome of death among general intensive care unit patients. In both
analyses, we found that the duration of mechanical ventilation was a
predictor of untoward outcomes.
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Affiliation(s)
- Patricia Mesa
- Unidade de Terapia Intensiva, Hospital Pasteur - Montevidéu, Uruguai
| | - Ignacio José Previgliano
- Unidade de Terapia Intensiva, Hospital Juan A. Fernández, Universidad Maimónides - Buenos Aires, Argentina
| | - Sonia Altez
- Unidade de Terapia Intensiva, Hospital Pasteur - Montevidéu, Uruguai
| | - Silvina Favretto
- Unidade de Terapia Intensiva, Hospital Pasteur - Montevidéu, Uruguai
| | - María Orellano
- Unidade de Terapia Intensiva, Hospital Pasteur - Montevidéu, Uruguai
| | | | - Ana Soca
- Unidade de Terapia Intensiva, Hospital Pasteur - Montevidéu, Uruguai
| | - E Wesley Ely
- Veteran's Affairs Geriatric Research Education and Clinical Center of the Tennessee Valley - Nashville, TN, Estados Unidos.,Vanderbilt University Medical Center - Nashville, TN, Estados Unidos
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Martínez F, Donoso AM, Marquez C, Labarca E. Implementing a Multicomponent Intervention to Prevent Delirium Among Critically Ill Patients. Crit Care Nurse 2017; 37:36-46. [DOI: 10.4037/ccn2017531] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND
Delirium is common among the critically ill. Nonpharmacologic interventions are reportedly effective in reducing incident delirium, but limited data specific to this population exist.
OBJECTIVES
To assess the efficacy and describe the implementation strategy of a multicomponent intervention to prevent delirium in an intensive care unit.
METHODS
A before-and-after study was conducted in an intensive care unit between May 2014 through August 2015. Adult participants were enrolled consecutively, excluding only those who refused to participate. Tailored interventions took available evidence into consideration. Components included early mobilization, physical therapy, reorientation, cognitive stimulation, drug reviews, environmental stimulation, avoidance of sensory deprivation, pain control, restraint use avoidance, and family participation. Incident delirium was assessed twice daily using the Confusion Assessment Method for the Intensive Care Unit. Multivariate logistic regression was used to control for confounders.
RESULTS
The study included 227 patients (54.7% male; mean [SD] age, 63.3 [18.3] years). Our strategy significantly reduced delirium (from 38% to 24%; relative risk, 0.62; 95% CI, 0.40–0.94; P = .02), an association that remained significant after adjusting for confounders. Adherence rates were more than 85% in all intervention domains (except daily reorientation) that were overseen by health care providers.
CONCLUSIONs
The strategy was successful in reducing delirium. Self-removals of invasive implements decreased, an observation that has not been previously described. No difference in mortality rate was seen, as has been reported in other studies. Early participation of the whole team, shared leadership, and the provision of concrete tasks were key to the success of this multicomponent intervention.
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Affiliation(s)
- Felipe Martínez
- Felipe Martínez is an intensive care physician at Unidad de Cuidados Intensivos Generales, Hospital Naval Almirante Nef, Viña del Mar, Chile, and a research coordinator at Area de Investigación y Estudios Clínicos, Clínica Ciudad del Mar, Viña del Mar, and a clinical researcher at Centro de Investigaciones Biomédicas, Escuela de Medicina, Universidad de Valparaíso, Centro de Investigaciones Biomédicas, Escuela de Medicina, Universidad de Valparaíso, Chile
| | - Ana María Donoso
- Ana María Donoso is an anesthesiologist at Unidad de Cuidados Intensivos Generales, Hospital Naval Almirante Nef
| | - Carla Marquez
- Carla Marquez is a clinical nurse at Unidad de Cuidados Intensivos Generales, Hospital Naval Almirante Nef
| | - Eduardo Labarca
- Eduardo Labarca is a senior intensivist at Unidad de Cuidados Intensivos Generales, Hospital Naval Almirante Nef
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Recognition and management of delirium among doctors, nurses, physiotherapists, and psychologists: an Italian survey. Int Psychogeriatr 2014; 26:2093-102. [PMID: 25137033 DOI: 10.1017/s1041610214001653] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are no studies that have identified the ability to recognize and manage delirium among Italian health providers caring for patients at risk. Therefore, the Italian Association of Psychogeriatrics (AIP) conducted a multicenter survey among doctors, nurses, psychologists and physiotherapists to assess their competence regarding the theme of delirium and its management in the everyday clinical practice. METHODS The survey period was 1st June 2013 to 30th November 2013. The invitation to participate was sent via email, with publication on the AIP website. The survey included 14 questions and two case vignettes. RESULTS A total of 648/1,500 responses were collected. Most responders were doctors (n = 322/800), followed by nurses (n = 225/500), psychologists (n = 51/100), and physiotherapists (n = 30/100). Generally, doctors and psychologists correctly defined delirium, while nurses and physiotherapists did not. The most frequently used diagnostic tools were the Confusion Assessment Method (CAM) and the Diagnostic and Statistical Manual of Mental Disorders-IV. Delirium intensity was rarely assessed. Hypoactive delirium was generally managed with non-pharmacological approaches, while hyperactive delirium with a combination of non-pharmacological and pharmacological approaches. However, possible causes of delirium were under-assessed by half of doctors and by the majority of other professionals. Nurses, psychologists and physiotherapists did not answer the case vignettes, while doctors identified the correct answer in most cases. CONCLUSIONS This is the first Italian survey among health providers caring for patients at risk of delirium. This is also the first survey including doctors, nurses, psychologists and physiotherapists. The results emphasize the importance of training to improve knowledge of this relevant unmet medical need.
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Abstract
BACKGROUND There are still substantial uncertainties over best practice in delirium care. The European Delirium Association (EDA) conducted a survey of its members and other interested parties on various aspects of delirium care. METHODS The invitation to participate in the online survey was distributed among the EDA membership. The survey covered assessment, treatment of hyperactive and hypoactive delirium, and organizational management. RESULTS A total of 200 responses were collected (United Kingdom 28.6%, Netherlands 25.3%, Italy 15%, Switzerland 9.7%, Germany 7.1%, Spain 3.8%, Portugal 2.5%, Ireland 2.5%, Sweden 0.6%, Denmark 0.6%, Austria 0.6%, and others 3.2%). Most of the responders were doctors (80%), working in geriatrics (45%) or internal medicine (14%). Ninety-two per cent of the responders assessed patients for delirium daily. The most commonly used assessment tools were the Confusion Assessment Method (52%) and the Delirium Observation Screening Scale (30%). The first-line choice in the management of hyperactive delirium was a combination of non-pharmacological and pharmacological approaches (61%). Conversely, non-pharmacological management was the first-line choice in hypoactive delirium (67%). Delirium awareness (34%), knowledge (33%), and lack of education (13%) were the most commonly reported barriers to improving the detection of delirium. Interestingly, 63% of the responders referred patients after an episode of delirium to a follow-up clinic. CONCLUSIONS This is the first systematic survey involving an international group of specialists in delirium. Several areas of lack of consensus were found. These results emphasise the importance of further research to improve care of this major unmet medical need.
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