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Su LJ, Chen MJ, Yang R, Zou H, Chen TT, Li SL, Xin HN, Hu RF. Investigating the correlation of delirium after cardiac surgery with memories and posttraumatic stress disorder consequences of intensive care unit: A prospective cohort study. Intensive Crit Care Nurs 2024; 82:103632. [PMID: 38290221 DOI: 10.1016/j.iccn.2024.103632] [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: 01/11/2024] [Accepted: 01/20/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES To explore the differences in post-intensive care unit memory and posttraumatic stress disorder symptoms between patients with and without delirium, and assess the correlations between the two. DESIGN Prospective cohort observation study. SETTING A cardiac intensive care unit of a tertiary hospital in China. We enrolled 318 consecutive patients after cardiac surgery between December 2017 and March 2019. MAIN OUTCOME MEASURES Delirium was assessed using the Confusion Assessment Method for the ICU from intensive care unit admission to discharge. Intensive care unit memory was assessed using the ICU-Memory Tool through face-to-face interviews one week after discharge. Posttraumatic stress disorder was measured telephonically using the Impact of Events Scale-revised questionnaire at three months post-discharge. RESULTS Eighty patients each in the delirium and non-delirium groups were enrolled for follow-up interviews. Patients with delirium had vaguer memories of pre-intensive care unit admission and of their stay, and recollected more memories of feelings (vs. without delirium). Posttraumatic stress disorder was diagnosed in 14 patients with and in seven without delirium, with non-significant differences between groups. Delirium did not influence post-intensive care unit factual, feeling, and delusional memories, nor posttraumatic stress disorder and hyperarousal, intrusion, and avoidance. The memories of feelings were positively correlated with the last three (r = 0.285, r = 0.390 and r = 0.373, respectively). CONCLUSION Patients with delirium had vague intensive care unit memories. Memories of feelings were positively correlated with symptoms of hyperarousal, intrusion, and avoidance. Delirium did not influence factual, feeling, or delusional memories nor posttraumatic stress disorder incidence and symptoms. IMPLICATIONS FOR CLINICAL PRACTICE Interventions are needed to reduce the impact of vague memory in patients with post-intensive care unit delirium. Memories of feelings should be focused on because of their correlation with hyperarousal, intrusion, and avoidance. Delirium prevention and early recognition measures are suggested.
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Affiliation(s)
- Li-Jing Su
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Mei-Jing Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Rong Yang
- Follow-Up Center, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Hong Zou
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Ting-Ting Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Sai-Lan Li
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Hui-Ning Xin
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province 350001, China.
| | - Rong-Fang Hu
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China.
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He X, Song Y, Cao Y, Miao L, Zhu B. Post intensive care syndrome: A review of clinical symptoms, evaluation, intervention. Heliyon 2024; 10:e31278. [PMID: 38803859 PMCID: PMC11128526 DOI: 10.1016/j.heliyon.2024.e31278] [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: 10/21/2023] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
Post intensive care syndrome (PICS) is a typical complication of critically ill patients during or after their stay in intensive care unit (ICU), characterized by a high incidence and impairment rate. It significantly impacts the quality of life of patients and their families, as well as consumes a substantial amount of medical resources. Therefore, early intervention and assessment of PICS is crucial. This paper aims to provide clinical professionals with a reference base by focusing on the clinical symptoms, diagnostic assessment, and preventative measures of PICS.
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Affiliation(s)
- Xiaofang He
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Yuwei Song
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Yuchun Cao
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Liying Miao
- Department of Nephrology, the Third Affiliated Hospital of Soochow University, Changzhou, 213000, Jiangsu, China
| | - Bin Zhu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
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Pozzi M, Ripa C, Meroni V, Ferlicca D, Annoni A, Villa M, Strepparava MG, Rezoagli E, Piva S, Lucchini A, Bellani G, Foti G. Hospital Memories and Six-Month Psychological Outcome: A Prospective Study in Critical Ill Patients with COVID-19 Respiratory Failure. J Clin Med 2023; 12:jcm12093344. [PMID: 37176785 PMCID: PMC10179721 DOI: 10.3390/jcm12093344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
ICU survivors suffer from various long-term physical and psychological impairments. Memories from the critical illness may influence long-term psychological outcome. In particular, the role of ICU memories in COVID-19 critically ill patients is unknown. In a prospective observational study, we aimed to investigate patients' memories from the experience of critical illness and their association with a six-month psychological outcome involving quality of life evaluation. Patients' memories were investigated with ICU Memory tool, while psychological outcome and quality of life were evaluated by means of a battery of validated questionnaires during an in-person interview at the follow-up clinic. 149 adult patients were enrolled. 60% retained memories from pre-ICU days spent on a general ward, while 70% reported memories from the in-ICU period. Delusional memories (i.e., memories of facts that never happened) were reported by 69% of patients. According to a multivariable analysis, the lack of pre-ICU memories was an independent predictor of worse psychological outcomes in terms of anxiety, depression and Post-traumatic Stress Disorder (PTDS). Factors associated with long-term outcome in ICU survivors are not still fully understood and patients' experience during the day spent before ICU admission may be associated with psychological sequelae.
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Affiliation(s)
- Matteo Pozzi
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Claudio Ripa
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Valeria Meroni
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Daniela Ferlicca
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Alice Annoni
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Marta Villa
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | | | - Emanuele Rezoagli
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, 25123 Brescia, Italy
| | - Alberto Lucchini
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giacomo Bellani
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giuseppe Foti
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
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Gómez Tovar LO, Henao-Castaño ÁM, Troche-Gutiérrez IY. Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team. ENFERMERIA INTENSIVA 2022; 33:113-125. [PMID: 35945109 DOI: 10.1016/j.enfie.2021.05.001] [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: 10/28/2020] [Accepted: 05/07/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. METHODOLOGY Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. RESULTS Four significant themes emerged from the analysis: (1) delirium prevention, (2) pharmacological treatment, (3) non-pharmacological treatment, and (4) barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. CONCLUSIONS The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.
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Affiliation(s)
- L O Gómez Tovar
- Programa de Enfermería, Universidad Surcolombiana, Neiva, Huila, Colombia.
| | - Á M Henao-Castaño
- Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá, Colombia
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Fukuda T, Watanabe N, Sakaki K, Monna Y, Terachi S, Miyazaki S, Kinoshita Y. Identifying cues of distorted memories in intensive care by focus group interview of nurses. Nurs Open 2021; 9:666-675. [PMID: 34719130 PMCID: PMC8685829 DOI: 10.1002/nop2.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/10/2021] [Accepted: 10/14/2021] [Indexed: 11/06/2022] Open
Abstract
AIM To determine cues to identify intensive care unit patients with distorted memories and related practices. DESIGN Qualitative descriptive study. METHODS Twenty nurses were included in semi-structured focus groups. Qualitative content analysis was conducted. RESULTS Cues and nursing practices related to distorted memories emerged under the following categories: "Get to know daily life before admission," "Facial expressions and behaviour are different from usual," "Pay close attention to the treatment outcome," "Notice it after the fact," "Sharing patients' intensive care unit experiences" and "Creates a new life." Nurses tried to detect distorted memories by observing the patients' facial expressions, medication effects and delirium presence during their normal lives and treatments, while trying to understand the patients' intensive care unit experiences and provide care that promotes autonomous living. This study emphasizes the importance of support for reconstructing ordinary life through communication and rehabilitation, in addition to support for medical care for distorted memories.
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Affiliation(s)
- Tomohide Fukuda
- Faculty of Nursing, Musashino University, Koto, Tokyo, Japan
| | - Naoki Watanabe
- Department of Nursing, Tokai University Hospital, Isehara,Kanagawa, Japan
| | - Kosuke Sakaki
- Department of Nursing, The Jikei University Hospital, Minato, Tokyo, Japan
| | - Yuriko Monna
- Department of Nursing, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Saori Terachi
- Department of Nursing, Tokai University Hospital, Isehara,Kanagawa, Japan
| | - Satoko Miyazaki
- Department of Nursing, Tokai University Hospital, Isehara,Kanagawa, Japan
| | - Yoshiko Kinoshita
- Department of Nursing, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
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Gómez Tovar LO, Henao-Castaño ÁM, Troche-Gutiérrez IY. Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team. ENFERMERIA INTENSIVA 2021; 33:S1130-2399(21)00081-X. [PMID: 34412959 DOI: 10.1016/j.enfi.2021.05.001] [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: 10/28/2020] [Revised: 03/23/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. METHODOLOGY Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. RESULTS Four significant themes emerged from the analysis: 1) Delirium prevention, 2) Pharmacological treatment, 3) Non-pharmacological treatment, and 4) Barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. CONCLUSIONS The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.
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Affiliation(s)
- L O Gómez Tovar
- Programa de Enfermería, Universidad Surcolombiana, Neiva, Huila, Colombia.
| | - Á M Henao-Castaño
- Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá, Colombia
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Luz LFDS, Santos MCD, Ramos TA, Almeida CBD, Rover MC, Dal'Pizzol CP, Pohren CLDS, Martins AVDS, Boniatti MM. Delirium and quality of life in critically ill patients: a prospective cohort study. Rev Bras Ter Intensiva 2021; 32:426-432. [PMID: 33053033 PMCID: PMC7595710 DOI: 10.5935/0103-507x.20200072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/23/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the association between the incidence of delirium in the intensive care unit and quality of life 1 month after hospital discharge. Methods This was a prospective cohort study conducted in the intensive care units of two medium-complexity hospitals from December 2015 to December 2016. Delirium was identified using the Confusion Assessment Method for the Intensive Care Unit scale. At the time of hospital discharge, functional capacity and cognition were assessed with the Barthel index and the Mini Mental State Examination, respectively. Thirty days after patient discharge, the World Health Organization Quality of Life-BREF questionnaire was administered by telephone. Results A total of 216 patients were included. Delirium was identified in 127 (58.8%) of them. Patients with delirium exhibited greater functional dependence (median Barthel index 50.0 [21.2 - 70.0] versus 80.0 [60.0 - 95.0]; p < 0.001) and lower cognition (Mini Mental State Examination score 12.9 ± 7.5 versus 20.7 ± 9.8; p < 0.001) at hospital discharge. There was no difference in any of the quality-of-life domains evaluated 1 month after hospital discharge between patients with and without delirium. Conclusion Our findings suggest that patients with delirium in the intensive care unit do not have worse quality of life 1 month after hospital discharge, despite presenting greater cognitive impairment and functional disability at the time of hospital discharge.
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Affiliation(s)
| | | | - Tiago Almeida Ramos
- Serviço de Medicina Intensiva, Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
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Bench S, Stayt L, Shah A, Dhiman P, Czuber-Dochan W. Prevalence and experience of fatigue in survivors of critical illness: a mixed-methods systematic review. Anaesthesia 2021; 76:1233-1244. [PMID: 33694157 DOI: 10.1111/anae.15441] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/11/2022]
Abstract
We conducted a mixed methods systematic review to investigate the prevalence, experience and management of fatigue in survivors of critical illness. We identified 76 studies investigating fatigue or vitality in adults discharged from an intensive care unit and split the extracted data into three datasets: vitality scores from the Short Form Health Survey-36 (n = 54); other quantitative data (n = 19); and qualitative data (n = 9). We assessed methodological quality using critical appraisal skills programme tools. We adopted a segregated approach to mixed-methods synthesis. In a final step, we attributed combined results to one of four qualitative themes: prevalence and severity; contributing factors; impacts on quality of life; and assessment and management. Prevalence of fatigue ranged from 13.8 to 80.9%. Short Form Health Survey-36 vitality scores were commonly used as a marker of fatigue. Vitality scores reached a nadir approximately one month following ICU discharge (mean (SD) 56.44 (32.30); 95%CI 52.92-59.97). They improved over time but seldom reached reference population scores. Associated biological, disease-related and psychological factors included age, poor pre-morbid status, sleep and psychological disturbance. Qualitative data highlight the profound negative impact of fatigue on survivors' quality of life. Survivors seldom had any information provided on the potential impact of fatigue. No fatigue assessment tools specific to critical illness or evidence-based interventions were reported. Fatigue is highly prevalent in survivors of critical illness, and negatively impacts recovery. Further research on developing fatigue assessment tools specifically for critically ill patients and evaluating the impact of pharmacological and non-pharmacology interventions is needed.
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Affiliation(s)
- S Bench
- School of Health and Social Care, London South Bank University, London, UK
| | - L Stayt
- Oxford Brookes University, Oxford, UK
| | - A Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - W Czuber-Dochan
- Florence Nightingale School of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Miyamoto K, Shibata M, Shima N, Nakashima T, Kida M, Matsumoto H, Oka N, Yazaki A, Uchigaki A, Takemoto A, Kato S. Combination of delirium and coma predicts psychiatric symptoms at twelve months in critically ill patients: A longitudinal cohort study. J Crit Care 2021; 63:76-82. [PMID: 33618284 DOI: 10.1016/j.jcrc.2021.01.007] [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: 09/23/2020] [Revised: 12/15/2020] [Accepted: 01/17/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE We aimed to determine any associations between delirium and comas during intensive care unit (ICU) stay, and long-term psychiatric symptoms and disability affecting activity of daily living (ADL). MATERIALS AND METHODS In this prospective observational study, we enrolled critically ill adult patients that were emergently admitted to an ICU. We assessed psychiatric symptoms and disability affecting ADL at three and twelve months after ICU discharge. RESULTS Among the 81 and the 47 patients that responded to the questionnaires at three and twelve months, 22 (27%) and 13 (28%) patients experienced delirium, respectively. During their ICU stay, 28 (35%) and 21 (45%) had been in comas, respectively. At three and twelve months, 51 (63%) and 23 (49%) of patients experienced composite psychiatric symptoms or disability affecting ADL, respectively. After adjusting predefined confounders, the combination of delirium and comas was an independent risk factor for the presence of composite psychiatric symptoms or disability affecting ADL (adjusted odds ratio [aOR] 3.38; 1.10-10.38 at three months; aOR 8.28; 1.48-46.46 at twelve months). CONCLUSIONS In critically ill adults, combination of delirium and comas during ICU stay is a predictor of psychiatric symptoms or ADL disability. TRIAL REGISTRATION UMIN Clinical Trial Registry no. UMIN000023743, September 1, 2016.
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Affiliation(s)
- Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan.
| | - Mami Shibata
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
| | - Nozomu Shima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
| | - Tsuyoshi Nakashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
| | - Maki Kida
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
| | - Haruka Matsumoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
| | - Natsuki Oka
- Department of Nursing, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City 641-8510, Wakayama, Japan
| | - Akina Yazaki
- Department of Nursing, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City 641-8510, Wakayama, Japan
| | - Akiko Uchigaki
- Department of Nursing, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City 641-8510, Wakayama, Japan
| | - Aya Takemoto
- Department of Nursing, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City 641-8510, Wakayama, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
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Abstract
Delirium is a manifestation of brain injury or acute and generalized dysfunction of the upper cerebral cortical processes. In this way, it is important to analyze delirium more broadly as a symptom to understand and intervene taking into account that it is manifesting the presence of brain lesions whose consequences are deleterious to the neurological performance of patients. This article is intended to present a comprehensive approach of delirium analyzed from a symptom perspective and from theoretical and conceptual structure, such as the Dynamic Symptoms Model, specific to the nursing practice. A literature review related to delirium and components of Dynamic Symptoms Model was carried out. We searched the MEDLINE, ScienceDirect, SciELO, and Scopus databases using the terms Delirium, Intensive Care Units, Nursing, and Risk Factor. The existing literature provides evidence of the antecedents, experience, interventions, interactions, and consequences of delirium, which are components of the Model. Thus, the analysis from the Dynamic Symptoms Model perspective bears relevance and contributes to the understanding and approach of delirium.
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Yoshino Y, Unoki T, Sakuramoto H, Ouchi A, Hoshino H, Matsuishi Y, Mizutani T. Association between intensive care unit delirium and delusional memory after critical care in mechanically ventilated patients. Nurs Open 2021; 8:1436-1443. [PMID: 33387449 PMCID: PMC8046113 DOI: 10.1002/nop2.760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/12/2020] [Accepted: 11/16/2020] [Indexed: 01/21/2023] Open
Abstract
AIM To determine the relationship between the delirium of patients with mechanical ventilation during intensive care unit (ICU) stay and delusional memory after ICU discharge. DESIGN Prospective cohort study. METHODS Delirium in adult patients who received mechanical ventilation for more than 24 hr was assessed twice daily using the Confusion Assessment Method for the ICU. Delusional memories were evaluated using the ICU Memory Tool 5-10 days after ICU discharge. The associations between the presence of delirium during the ICU stay and delusional memories were evaluated. RESULTS Of 60 enrolled patients, 62% had delirium during their ICU stay, and 68% experienced delusional memories 5-10 days after discharge. Delirium during ICU stay was an independent factor to experience delusional memories following discharge. Preventing delirium during ICU stay might reduce delusional memory. We recommend that patients with delirium during their ICU stay should be carefully followed up after discharge from the ICU.
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Affiliation(s)
- Yasuyo Yoshino
- Kanto Gakuin University College of Nursing, Yokohama, Japan
| | - Takeshi Unoki
- Department of Adult Health Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Akira Ouchi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Haruhiko Hoshino
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yujiro Matsuishi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Fukuda T, Kinoshita Y, Shirahama T, Miyazaki S, Watanabe N, Misawa T. Distorted Memories and Related Factors in ICU Patients. Clin Nurs Res 2020; 31:39-45. [PMID: 33289396 DOI: 10.1177/1054773820980162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to examine the relationship between memory status of and factors related to patients in the intensive care unit (ICU) using a cross-sectional study design. Participants were adult patients who were admitted to the general ICUs for more than 48 hours. One week after ICU discharge, a survey on memory distortion was conducted. Overall, 133 patients were included, of whom 51.1% reported distorted memories. Among them, 15.0% had memory loss; 48.1% had unrealistic experiences; 27.8% recalled confusion, panic, anxiety, and discomfort during their ICU stay; and 9% had traumatic experiences. Multiple logistic regression analyses revealed that memory loss was associated with an operation, and a significant association was observed between traumatic memory and pain. Opioid use may have a protective effect against memory loss. These results suggest the importance of relieving pain and preserving true memories during ICU treatment.
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Abstract
Surviving a critical illness can have long-term effects on both patients and families. These effects can be physical, emotional, cognitive, and social, and they affect both the patient and the family. Family members play a key role in helping their loved one recover, and this recovery process can take considerable time. Transferring out of an intensive care unit, and discharging home from a hospital, are important milestones, but they represent only the beginning of recovery and healing after a critical illness. Recognizing that these challenges exist both for patients and families is important to improve critical illness outcomes.
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Wanting to Forget: Intrusive and Delusional Memories from Critical Illness. Case Rep Crit Care 2020; 2020:7324185. [PMID: 32274218 PMCID: PMC7128039 DOI: 10.1155/2020/7324185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction. Delusional and fearful memories after critical illness are observed in up to 70% of patients post critical illness. However, they often go unrecognized after patients leave the intensive care unit (ICU). Case Presentation. A 40-year-old male was admitted to the ICU with community-acquired pneumonia and multiorgan failure requiring mechanical ventilation and renal replacement therapy. He developed protracted delirium and severe ICU-acquired weakness but was eventually discharged home. The patient returned to a follow-up clinic two months post-ICU discharge and revealed that he was suffering anxiety from memories in the ICU of different staff trying to harm and kill him, including being repeatedly suffocated. By providing context to the memories, the patient had significant relief in his anxiety. Conclusions. Intrusive memories contribute to psychological morbidity post critical illness, including posttraumatic stress disorder (PTSD) and reduced health-related quality of life. The majority of critical illness survivors do not share their intrusive or frightening memories, and therefore, most healthcare professionals are unaware of the problems they can pose. Assessment of patients' memories from the ICU is essential and may create the opportunity to help patients place memories into context and improve psychological morbidities.
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Barreto BB, Luz M, Rios MNDO, Lopes AA, Gusmao-Flores D. The impact of intensive care unit diaries on patients' and relatives' outcomes: a systematic review and meta-analysis. Crit Care 2019; 23:411. [PMID: 31842929 PMCID: PMC6916011 DOI: 10.1186/s13054-019-2678-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Memory gaps in intensive care unit (ICU) survivors are associated with psychiatric disorders. The ICU diaries improve the patient's factual memory of the ICU, but it is not clear if they reduce the incidence of psychiatric disorders in patients and relatives after hospital discharge. The aim of this study is to evaluate the literature on the effect of ICU diaries for patients admitted in ICU and their relatives. METHODS Two authors independently searched the online databases PubMed, OVID, Embase, EBSCO host, and PsycINFO from inception to July 2019. Studies were included if the intervention group (ICU diary) was compared with a group with no diaries and the sample was comprised patients ≥ 18 years old admitted in the ICU for more than 24 h and their relatives. Randomized clinical trials, observational studies, letter with original data, and abstracts were included, irrespective of the language. The search was not limited by any specific outcome. Review articles, commentaries, editorials, and studies without a control group were excluded. Structured tools were used to assess the methodological quality ("Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I)" for cohort studies and the "Cochrane Risk of Bias tool" for included RCTs and before/after studies). A random-effects model was employed considering the anticipated variability between the studies. RESULTS Seven hundred eighty-five titles were identified for screening. Two additional studies were selected after a reference search, and after a full-text review, a total of 12 studies were included. When pooling the results, ICU diary was associated with lower risk of depression (RR 0.41, 95% CI 0.23-0.75) and better quality of life (10.3 points higher in SF-36 general health score, 95% CI 0.79-19.8), without a decrease in anxiety or post-traumatic stress disorder (PTSD). For the relatives receiving an ICU diary, there was no difference in the incidence of PTSD, anxiety, or depression. CONCLUSION AND RELEVANCE This systematic review and meta-analysis supports the use of ICU diaries to reduce the risk of depression and preserve the quality of life of patients after ICU admission. ICU diaries do not seem to have any beneficial effect on the relatives of the patients. TRIAL REGISTRATION PROSPERO, CRD42019136639.
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Affiliation(s)
- Bruna Brandao Barreto
- Intensive Care Unit, Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, Bahia 40411-900 Brazil
| | - Mariana Luz
- Intensive Care Unit, Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, Bahia 40411-900 Brazil
| | | | - Antonio Alberto Lopes
- Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
- Departamento de Medicina Interna e Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia Brazil
| | - Dimitri Gusmao-Flores
- Intensive Care Unit, Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, Bahia 40411-900 Brazil
- Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
- Departamento de Medicina Interna e Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia Brazil
- Intensive Care Unit, Hospital da Cidade, Salvador, Bahia Brazil
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Abstract
Delirium is a significant medical condition that is common in hospitalized patients. Beyond the increased risk of mortality, patients who experience an episode of delirium often go on to develop long-term psychiatric disturbance, including symptoms of post-traumatic stress disorder (PTSD). While there is a growing interest in understanding the complex relationship between delirium and PTSD, the existing literature is sparse and lacking harmony. Thus, this review seeks to develop a unified and thorough description of the cognitive and psychiatric underpinnings of post-delirium PTSD with the aims of promoting awareness of this condition amongst clinicians in medical settings, improving patient care, and sparking further research on this topic. While specific underlying mechanisms are yet unclear, PTSD was found to be associated with delirium in that delirious patients may have decreased factual recall of hospital events and increased hallucinations/delusions of a traumatic nature. Several potential interventions were identified, as well as suggestions for future research and clinical practice.
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Wan R, McKenzie CA, Taylor D, Camporota L, Ostermann M. Acute kidney injury as a risk factor of hyperactive delirium: A case control study. J Crit Care 2019; 55:194-197. [PMID: 31756583 DOI: 10.1016/j.jcrc.2019.10.013] [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: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Delirium and acute kidney injury (AKI) are common organ dysfunctions during critical illness. Both conditions are associated with serious short- and long-term complications. We investigated whether AKI is a risk factor for hyperactive delirium. METHODS This was a single-centre case control study conducted in a 30 bedded mixed Intensive Care Unit in the UK. Hyperactive delirium cases were identified by antipsychotic initiation and confirmation of delirium diagnosis through validated chart review. Cases were compared with non-delirium controls matched by Acute Physiology and Chronic Health Evaluation II score and gender. AKI was defined by the KDIGO criteria. RESULTS 142 cases and 142 matched controls were identified. AKI stage 3 was independently associated with hyperactive delirium [Odds ratio (OR) 5.40 (95% confidence interval (CI) 2.33-12.51]. Other independent risk factors were mechanical ventilation [OR 2.70 (95% CI 1.40-5.21)], alcohol use disorder [OR 5.80 (95% CI 1.90-17.72)], and dementia [OR 9.76 (95% CI 1.09-87.56)]. Hospital length of stay was significantly longer in delirium cases (29 versus 20 days; p = .004) but hospital mortality was not different. CONCLUSIONS AKI stage 3 is independently associated with hyperactive delirium. Further research is required to explore the factors that contribute to this association.
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Affiliation(s)
- Ryy Wan
- Department of Pharmacy, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK.
| | - C A McKenzie
- Institute of Pharmaceutical Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK; Department of Pharmacy, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - D Taylor
- Institute of Pharmaceutical Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK; Department of Pharmacy, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - L Camporota
- King's College London, Department of Critical Care, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - M Ostermann
- King's College London, Department of Critical Care, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
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18
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Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2019; 46:e825-e873. [PMID: 30113379 DOI: 10.1097/ccm.0000000000003299] [Citation(s) in RCA: 1808] [Impact Index Per Article: 361.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. DESIGN Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process. Teleconferences and electronic discussions among subgroups and whole panel were part of the guidelines' development. A general content review was completed face-to-face by all panel members in January 2017. METHODS Content experts, methodologists, and ICU survivors were represented in each of the five sections of the guidelines: Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as "strong," "conditional," or "good" practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. RESULTS The Pain, Agitation/Sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered prioritized question list remained without recommendation. CONCLUSIONS We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) management and provide the foundation for improved outcomes and science in this vulnerable population.
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Incidence, risk factors, and cumulative risk of delirium among ICU patients: A case-control study. Int J Nurs Sci 2019; 6:247-251. [PMID: 31508442 PMCID: PMC6722464 DOI: 10.1016/j.ijnss.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 05/25/2019] [Accepted: 05/31/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives Delirium is a common acute cognitive impairment syndrome among intensive care unit (ICU) patients. This study was aimed to investigate the incidence, risk factors, and cumulative risk of delirium among ICU patients. Methods A case-control study including clinical records of 452 patients were retrospectively analyzed. Delirium was assessed using the Confusion Assessment Method for the ICU and Richmond Agitation–Sedation Scale. Results We found that 163 out of the 452 patients (36.1%) had delirium. Multivariate analysis showed that use of sedatives, length of ICU hospitalization, and physical restraint were independent risk factors for delirium. The additive effect of all three factors resulted to an odds ratio of 30.950. Conclusion The incidence of delirium remained high. Thus, nurses shall strengthen the monitoring of delirium, regularly access the patient's level of calmness, and limit the use of physical restraint.
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Takashima N, Yosihno Y, Sakaki K. Quantitative and qualitative investigation of the stress experiences of intensive care unit patients mechanically ventilated for more than 12 hr. Jpn J Nurs Sci 2019; 16:468-480. [DOI: 10.1111/jjns.12253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/09/2018] [Accepted: 12/30/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Naomi Takashima
- Department of Critical Care NursingCollege of Nursing Kanto Gakuin University Yokohama Japan
| | - Yasuyo Yosihno
- Department of Critical Care Nursing, College of NursingKanto Gakuin University Yokohama Japan
| | - Kosuke Sakaki
- Nursing Department, Tokyo Jikei University Hospital Tokyo Japan
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Larsen LK, Frøkjaer VG, Nielsen JS, Skrobik Y, Winkler Y, Møller K, Petersen M, Egerod I. Delirium assessment in neuro-critically ill patients: A validation study. Acta Anaesthesiol Scand 2019; 63:352-359. [PMID: 30324653 DOI: 10.1111/aas.13270] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/09/2018] [Accepted: 09/11/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Delirium is underinvestigated in the neuro-critically ill, although the harmful effect of delirium is well established in patients in medical and surgical intensive care units (ICU).To detect delirium, a valid tool is needed. We hypothesized that delirium screening would be feasible in patients with acute brain injury and we aimed to validate and compare the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist against clinical International Classification of Diseases-10 criteria as reference. METHODS Nurses assessed delirium using the Confusion Assessment Method for the ICU and Intensive Care Delirium Screening Checklist in adult patients with acute brain injury admitted to the Neurointensive care unit (Neuro-ICU), Copenhagen University Hospital, if their Richmond agitation-sedation scale score was -2 or above. As the reference, a team of psychiatrist assessed patients using the International Classification of Diseases-10 criteria. RESULTS We enrolled 74 patients, of whom 25 (34%) were deemed unable to assess by the psychiatrists, leaving 49 (66%) for final analysis. Sensitivity and specificity for the Confusion Assessment Method for the ICU was 59% (95% CI: 41-75) and 56% (95% CI: 32-78), respectively, and 85% (95% CI: 70-94) and 75% (95% CI: 51-92), respectively, for the Intensive Care Delirium Screening Checklist. CONCLUSIONS Our findings suggest that the Intensive Care Delirium Screening Checklist may be a valid tool and the Confusion Assessment Method for the ICU is less suitable for delirium detection for patients in the Neuro-ICU. In the neuro-critically ill, delirium screening is challenged by limited feasibility.
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Affiliation(s)
- Laura Krone Larsen
- Copenhagen University Hospital - Rigshospitalet, Department of Neuroanaesthesiology; The Neurosciences Centre, Neurointensive care unit 2093; Copenhagen Denmark
| | - Vibe G. Frøkjaer
- Copenhagen University Hospital - Rigshospitalet, Neurobiology Research Unit and Centre for Integrated Molecular Brain Imaging; Copenhagen University Hospital - Rigshospitalet, Mental Health Services; Copenhagen Denmark
| | - Jette Stub Nielsen
- Mental health service, Capital Region; Department of psychiatry; Ballerup Denmark
| | - Yoanna Skrobik
- McGill University Health Centre; Department of Medicine; Montreal, Quebec Canada
| | - Yvonne Winkler
- Mental health services, Capital Region; Community Mental Health Centre; Glostrup Denmark
| | - Kirsten Møller
- Copenhagen University Hospital - Rigshospitalet; Department of Neuroanaesthesiology; Copenhagen Denmark
| | - Marian Petersen
- Zealand University Hospital; Department of Surgery; Koge Denmark
| | - Ingrid Egerod
- Copenhagen University Hospital - Rigshospitalet, Intensive Care Unit 4131; University of Copenhagen; Health & Medical Sciences; Copenhagen Denmark
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22
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McIlroy PA, King RS, Garrouste-Orgeas M, Tabah A, Ramanan M. The Effect of ICU Diaries on Psychological Outcomes and Quality of Life of Survivors of Critical Illness and Their Relatives. Crit Care Med 2019; 47:273-279. [DOI: 10.1097/ccm.0000000000003547] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Gerth AMJ, Hatch RA, Young JD, Watkinson PJ. Changes in health-related quality of life after discharge from an intensive care unit: a systematic review. Anaesthesia 2019; 74:100-108. [PMID: 30291744 PMCID: PMC6586053 DOI: 10.1111/anae.14444] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 12/26/2022]
Abstract
Quality of life after critical illness is becoming increasingly important as survival improves. Various measures have been used to study the quality of life of patients discharged from intensive care. We systematically reviewed validated measures of quality of life and their results. We searched PubMed, CENTRAL, CINAHL, Web of Science and Open Grey for studies of quality of life, measured after discharge from intensive care. We categorised studied populations as: general; restricted to level-3 care or critical care beyond 5 days; and septic patients. We included quality of life measured at any time after hospital discharge. We identified 48 studies. Thirty-one studies used the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and 19 used the EuroQol-5D (EQ-5D); eight used both and nine used alternative validated measures. Follow-up rates ranged from 26-100%. Quality of life after critical care was worse than for age- and sex-matched populations. Quality of life improved for one year after hospital discharge. The aspects of life that improved most were physical function, physical role, vitality and social function. However, these domains were also the least likely to recover to population norms as they were more profoundly affected by critical illness.
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Affiliation(s)
- A. M. J. Gerth
- Critical Care Research GroupNuffield Department of Clinical NeurosciencesUniversity of OxfordUK
| | - R. A. Hatch
- Critical Care Research GroupNuffield Department of Clinical NeurosciencesUniversity of OxfordUK
| | - J. D. Young
- Critical Care Research GroupNuffield Department of Clinical NeurosciencesUniversity of OxfordUK
| | - P. J. Watkinson
- Critical Care Research GroupNuffield Department of Clinical NeurosciencesUniversity of OxfordUK
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Acute Kidney Injury and Delirium: Kidney–Brain Crosstalk. ANNUAL UPDATE IN INTENSIVE CARE AND EMERGENCY MEDICINE 2019 2019. [DOI: 10.1007/978-3-030-06067-1_31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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25
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Prognosis of neurologic complications in critical illness. HANDBOOK OF CLINICAL NEUROLOGY 2017. [PMID: 28190446 DOI: 10.1016/b978-0-444-63599-0.00041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Neurologic complications of critical illness require extensive clinical and neurophysiologic evaluation to establish a reliable prognosis. Many sequelae of intensive care unit (ICU) treatment, such as delirium and ICU-acquired weakness, although highly associated with adverse outcomes, are less suitable for prognostication, but should rather prompt clinicians to seek previously unnoticed persisting underlying illnesses. Prognostication can be confounded by drug administration particularly because its clearance is abnormal in critical illness. Some neurological complications are severe, and can last for months or years after discharge from ICU. The most important ethical aspects regarding neurologic complications in critically ill patients are prevention, recognition, and identification, and prevention of self-fulfilling prophecies. This chapter summarizes the tool of prognostication of major neurological complications of critical illness.
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Engwall M, Fridh I, Jutengren G, Bergbom I, Sterner A, Lindahl B. The effect of cycled lighting in the intensive care unit on sleep, activity and physiological parameters: A pilot study. Intensive Crit Care Nurs 2017; 41:26-32. [PMID: 28268055 DOI: 10.1016/j.iccn.2017.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 01/09/2017] [Accepted: 01/22/2017] [Indexed: 12/26/2022]
Abstract
Patients in intensive care suffer from severe illnesses or injuries and from symptoms related to care and treatments. Environmental factors, such as lighting at night, can disturb patients' circadian rhythms. The aim was to investigate whether patients displayed circadian rhythms and whether a cycled lighting intervention would impact it. In this pilot study (N=60), a cycled lighting intervention in a two-bed patient room was conducted. An ordinary hospital room functioned as the control. Patient activity, heart rate, mean arterial pressure and body temperature were recorded. All data were collected during the patients' final 24h in the intensive care unit. There was a significant difference between day and night patient activity within but not between conditions. Heart rates differed between day and night significantly for patients in the ordinary room but not in the intervention room or between conditions. Body temperature was lowest at night for all patients with no significant difference between conditions. Patients in both conditions had a natural circadian rhythm; and the cycled lighting intervention showed no significant impact. As the sample size was small, a larger repeated measures study should be conducted to determine if other types of lighting or environmental factors can impact patients' well-being.
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Affiliation(s)
- Marie Engwall
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, SE-50190 Borås, Sweden; Sahlgrenska Academy, Gothenburg University and the Institute of Health & Caring Sciences, Arvid Wallgrens Backe 1, SE 41346 Gothenburg, Sweden.
| | - Isabell Fridh
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, SE-50190 Borås, Sweden.
| | - Göran Jutengren
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, SE-50190 Borås, Sweden.
| | - Ingegerd Bergbom
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, SE-50190 Borås, Sweden; Sahlgrenska Academy, Gothenburg University and the Institute of Health & Caring Sciences, Arvid Wallgrens Backe 1, SE 41346 Gothenburg, Sweden.
| | - Anders Sterner
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, SE-50190 Borås, Sweden.
| | - Berit Lindahl
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, SE-50190 Borås, Sweden; Sahlgrenska Academy, Gothenburg University and the Institute of Health & Caring Sciences, Arvid Wallgrens Backe 1, SE 41346 Gothenburg, Sweden.
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27
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Franck M, Nerlich K, Neuner B, Schlattmann P, Brockhaus WR, Spies CD, Radtke FM. No convincing association between post-operative delirium and post-operative cognitive dysfunction: a secondary analysis. Acta Anaesthesiol Scand 2016; 60:1404-1414. [PMID: 27578364 DOI: 10.1111/aas.12779] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 07/30/2016] [Accepted: 08/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Post-operative delirium and post-operative cognitive dysfunction (POCD) are both common but it has not been clarified how closely they are associated. We aimed to assess the possible relationship in a secondary analysis of data from the 'Surgery Depth of anaesthesia and Cognitive outcome'- study. METHODS We included patients aged ≥ 60 years undergoing non-cardiac surgery planned for longer than 60 min. Delirium was assessed according to the Diagnostic and Statistical Manual of Mental Disorders IV criteria in the post-anaesthesia care unit (PACU) as well as within the first week after surgery. Cognitive function was assessed with a neuropsychological test battery. Multivariable analysis of POCD was performed with consideration of predisposing and precipitating factors. RESULTS Of 1277 randomized patients, 850 (66.6%) had complete data. Delirium was found in 270 patients (32.9% of 850). We detected POCD in 162 (20.9% of 776) at 1 week and in 52 (9.4% of 553) at 3 months. In multivariable analysis (n = 808), delirium had no overall effect on POCD (P = 0.30). Patients with no delirium in PACU but with postoperative delirium within 7 days had an increased risk of POCD at 3 months (OR = 2.56 (95%-confidence interval: 1.07-6.16), P = 0.035). No significant association was found for the other subgroups. CONCLUSIONS There is no clear evidence that postoperative delirium is independently associated with POCD up to 3 months.
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Affiliation(s)
- M. Franck
- Department of Anaesthesiology and Intensive Care Medicine; Campus-Virchow-Klinikum and Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. Nerlich
- Department of Anaesthesiology and Intensive Care Medicine; Campus-Virchow-Klinikum and Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - B. Neuner
- Department of Anaesthesiology and Intensive Care Medicine; Campus-Virchow-Klinikum and Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - P. Schlattmann
- Department of Medical Statistics, Informatics and Documentation; University Hospital Jena; Jena Germany
| | - W. R. Brockhaus
- Department of Anaesthesiology and Intensive Care Medicine; Campus-Virchow-Klinikum and Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - C. D. Spies
- Department of Anaesthesiology and Intensive Care Medicine; Campus-Virchow-Klinikum and Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - F. M. Radtke
- Department of Anaesthesiology and Intensive Care Medicine; Campus-Virchow-Klinikum and Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin Germany
- Anaestesiafdelingen; Naestved Sygehus; Naestved Denmark
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Svenningsen H, Egerod I, Dreyer P. Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur's interpretation theory. J Clin Nurs 2016; 25:2807-15. [DOI: 10.1111/jocn.13318] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Helle Svenningsen
- Department of Nursing; Faculty of Health Sciences; VIA University College; Aarhus N Denmark
| | - Ingrid Egerod
- University of Copenhagen Health & Medical Sciences Rigshospitalet; Trauma Center HOC 3193; Copenhagen Denmark
| | - Pia Dreyer
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus C Denmark
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29
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Orwelius L, Teixeira-Pinto A, Lobo C, Costa-Pereira A, Granja C. The role of memories on health-related quality of life after intensive care unit care: an unforgettable controversy? PATIENT-RELATED OUTCOME MEASURES 2016; 7:63-71. [PMID: 27350762 PMCID: PMC4902152 DOI: 10.2147/prom.s89555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Decreased health-related quality of life (HRQoL) is a significant problem after an intensive care stay and is affected by several known factors such as age, sex, and previous health-state. The objective of this study was to assess the association between memory and self-reported perceived HRQoL of patients discharged from the intensive care unit (ICU). Methods A prospective, multicenter study involving nine general ICUs in Portugal. All adult patients with a length of stay >48 hours were invited to participate in a 6-month follow-up after ICU discharge by answering a set of structured questionnaires, including EuroQol 5-Dimensions and ICU memory tool. Results A total of 313 (52% of the eligible) patients agreed to enter the study. The median age of patients was 60 years old, 58% were males, the median Simplified Acute Physiology Score II (SAPS II) was 38, and the median length of stay was 8 days for ICU and 21 days for total hospital stay. Eighty-nine percent (n=276) of the admissions were emergencies. Seventy-eight percent (n=234) of the patients had memories associated with the ICU stay. Patients with no memories had 2.1 higher chances (P=0.011) of being in the bottom half of the HRQoL score (<0.5 Euro-Qol 5-Dimensions index score). Even after adjusting for pre-admission characteristics, having memories was associated with higher perceived HRQoL (adjusted odds ratio =2.1, P=0.022). Conclusion This study suggests that most of the ICU survivors have memories of their ICU stay. For the ICU survivors, having memories of the ICU stay is associated with a higher perceived HRQoL 6 months after ICU discharge.
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Affiliation(s)
- Lotti Orwelius
- Department of Health Information and Decision Sciences, Faculty of Medicine of Porto, Porto, Portugal; CINTESIS - Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal; Department of Intensive Care, Linköping University, County Council of Östergötland, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Armando Teixeira-Pinto
- CINTESIS - Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal; Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Cristina Lobo
- CINTESIS - Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal
| | - Altamiro Costa-Pereira
- Department of Health Information and Decision Sciences, Faculty of Medicine of Porto, Porto, Portugal; CINTESIS - Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal
| | - Cristina Granja
- Department of Health Information and Decision Sciences, Faculty of Medicine of Porto, Porto, Portugal; CINTESIS - Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal; Department of Emergency and Intensive Care Medicine, Algarve Hospital Centre, Algarve, Portugal; Department of Biomedical Sciences and Medicine, University of Algarve, Algarve, Portugal
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Tramm R, Ilic D, Murphy K, Sheldrake J, Pellegrino V, Hodgson C. A qualitative exploration of acute care and psychological distress experiences of ECMO survivors. Heart Lung 2016; 45:220-6. [PMID: 26916455 DOI: 10.1016/j.hrtlng.2016.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 01/23/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To explore the acute care experience of extracorporeal membrane oxygenation (ECMO) patients. BACKGROUND ECMO is used in life-threatening scenarios of acute lung or heart failure. The patient's experience with ECMO treatment and the psychological distress are unknown. METHODS Qualitative analysis of semi-structured interviews with ECMO survivors 12 months after discharge were conducted and thematically analyzed. RESULTS Ten participants treated with ECMO for life-threatening acute heart or lung failure were interviewed. Six themes that captured the ICU experience of ECMO patients were identified including; dealing with crisis, critical care, memory, role of significant others and existence today and tomorrow. Deconditioning was the most frequently reported experience. Patchy factual memories contrasted with detailed delirious memories and paranoid ideations. CONCLUSION Patients treated with ECMO experienced deconditioning, perceived threats of serious injury or death and delusional episodes with recalls of psychological distress.
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Affiliation(s)
- Ralph Tramm
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre L6, 99 Commercial Rd, Prahran, 3004 Melbourne, Australia.
| | - Dragan Ilic
- Department of Epidemiology and Preventive Medicine (DEPM), Monash University, The Alfred Centre L6, 99 Commercial Rd, Prahran, 3004 Melbourne, Australia
| | - Kerry Murphy
- Department of Epidemiology and Preventive Medicine (DEPM), Monash University, The Alfred Centre L6, 99 Commercial Rd, Prahran, 3004 Melbourne, Australia
| | - Jayne Sheldrake
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Commercial Rd, Prahran, 3004 Melbourne, Australia
| | - Vincent Pellegrino
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Commercial Rd, Prahran, 3004 Melbourne, Australia
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre L6, 99 Commercial Rd, Prahran, 3004 Melbourne, Australia
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Flaigle MC, Ascenzi J, Kudchadkar SR. Identifying Barriers to Delirium Screening and Prevention in the Pediatric ICU: Evaluation of PICU Staff Knowledge. J Pediatr Nurs 2016; 31:81-4. [PMID: 26362671 PMCID: PMC4724532 DOI: 10.1016/j.pedn.2015.07.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 12/16/2022]
Abstract
Delirium in the pediatric intensive care unit (PICU) setting is often unrecognized and undertreated. The importance of screening and identification of ICU delirium has been identified in both adult and pediatric literature. Delirium increases ICU morbidity, length of mechanical ventilation and length of stay. The objective of this study was to determine the current knowledge level about delirium and its risk factors among pediatric critical care nurses through a short questionnaire. We hypothesized that before a targeted educational intervention, PICU care providers do not have an adequate knowledge base for accurate screening and diagnosis of delirium in critically ill children. A 17 question online survey was given to all nurses in a tertiary 36-bed PICU to assess current knowledge about delirium in children. The response rate was 73% (105/143). When asked to identify the correct way to diagnose pediatric delirium, 11.4% of nurses surveyed (12/105) incorrectly believed that Glasgow Coma Score is the appropriate screening tool. A large proportion of respondents (40/105) believed that benzodiazepines are helpful in treatment of delirium. The results of the survey identified specific knowledge gaps about risk factors and treatment of pediatric delirium in the critically ill child. There is a critical need for education about pediatric delirium and its risk factors among PICU staff prior to unit-wide implementation of a delirium screening and prevention program, specifically with regards to screening methods and pharmacologic risk factors. These results are likely generalizable to all physicians, nurses and staff who care for critically ill children.
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Affiliation(s)
- Melanie Cooper Flaigle
- Department of Anesthesiology and Critical Care Medicine & Pediatrics, Johns Hopkins University, Maryland
| | | | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine & Pediatrics, Johns Hopkins University, Maryland.
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Symptoms of Posttraumatic Stress after Intensive Care Delirium. BIOMED RESEARCH INTERNATIONAL 2015; 2015:876947. [PMID: 26557708 PMCID: PMC4628708 DOI: 10.1155/2015/876947] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/20/2015] [Accepted: 05/27/2015] [Indexed: 12/29/2022]
Abstract
Introduction. Long-term psychological consequences of critical illness are receiving more attention in recent years. The aim of our study was to assess the correlation of ICU-delirium and symptoms of posttraumatic stress disorder (PTSD) anxiety and depression after ICU-discharge in a Danish cohort. Methods. A prospective observational cohort study assessing the incidence of delirium in the ICU. Psychometrics were screened by validated tools in structured telephone interviews after 2 months (n = 297) and 6 months (n = 248) after ICU-discharge. Results. Delirium was detected in 54% of patients in the ICU and symptoms of PTSD in 8% (2 months) and 6% (6 months) after ICU-discharge. Recall of ICU stay was present in 93%. Associations between ICU-delirium and post-discharge PTSD-symptoms were weak and insignificant. Memories of delusions were significantly associated with anxiety after two months. Remaining associations between types of ICU-memories and prevalence of post-discharge symptoms of PTSD, anxiety, and depression were insignificant after adjusting for age. Incidence of ICU-delirium was unaffected by preadmission use of psychotropic drugs. Prevalence of PTSD-symptoms was unaffected by use of antipsychotics and sedation in the ICU. Conclusion. ICU-delirium did not increase the risk of PTSD-symptoms at 2 and 6 months after ICU discharge.
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Zhao J, Yao L, Wang C, Sun Y, Sun Z. The effects of cognitive intervention on cognitive impairments after intensive care unit admission. Neuropsychol Rehabil 2015; 27:301-317. [PMID: 26313129 DOI: 10.1080/09602011.2015.1078246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients who survive critical illness commonly suffer cognitive impairments. We aimed to study the effects of cognitive intervention to treat the long-term impairments observed among different populations of intensive care unit (ICU) survivors. The results showed that the intervention significantly suppressed the deterioration of cognitive function in these patients. Medical and neurological ICU survivors were more susceptible than post-anaesthesia ICU patients to severe cognitive damage. In the former, the deterioration of impairments can be slowed by cognitive intervention. In comparison, intervention exerted significantly positive effects on the recovery of the cognitive functions of post-anaesthesia care unit patients. Furthermore, young populations were more likely than older populations to recover from acute cognitive impairments, and the impairment observed among the older population seemed to be multi-factorial and irreversible.
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Affiliation(s)
- Jingjing Zhao
- a The First Affiliated Hospital of Anhui Medical University , Hefei , China.,b Department of Intensive Care Medicine , Hefei NO.2 People Hospital , Hefei , China
| | - Li Yao
- a The First Affiliated Hospital of Anhui Medical University , Hefei , China.,b Department of Intensive Care Medicine , Hefei NO.2 People Hospital , Hefei , China
| | - Changqing Wang
- a The First Affiliated Hospital of Anhui Medical University , Hefei , China.,b Department of Intensive Care Medicine , Hefei NO.2 People Hospital , Hefei , China
| | - Yun Sun
- a The First Affiliated Hospital of Anhui Medical University , Hefei , China.,b Department of Intensive Care Medicine , Hefei NO.2 People Hospital , Hefei , China
| | - Zhongwu Sun
- a The First Affiliated Hospital of Anhui Medical University , Hefei , China.,b Department of Intensive Care Medicine , Hefei NO.2 People Hospital , Hefei , China
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Abstract
BACKGROUND In the 21st century, we are starting to discover and understand the longer term sequelae of critical illness from both patient's and family members' perspectives. The consequential effects on physical and psychological function and the social landscape are being slowing realized. We are beginning to understand the long-term legacy of critical care, with survivorship possibly the greatest challenge within the critical care setting. AIM To draw together research that has appraised the experience of surviving critical illness from the holistic, triadic perspectives of survivor, relative and critical care nurse. In doing so, knowledge of the complexities of the critical care trajectory is enhanced. SEARCH STRATEGY Using Medline; Assia; CINAHL Plus; SCOPUS; Web of knowledge searches from 2000 to 2015 were conducted utilizing the terms 'critical care'; 'intensive care', ITU; patient*; relative*; family member*; experience*; nurse*, and trajectory. Relevant exclusion criteria were applied to provide a generalist adult critical care perspective. RESULTS Following a process of constant comparative analysis of the literature and thematic synthesis, seven themes were highlighted. Facing mortality, critical junctures, physiological sequelae, psychological sequelae, family presence, beyond meeting the needs of family members and technology versus humanity were all emergent themes. CONCLUSION As humans, we do not live an isolated life; we are interdependent upon each other. This inclusive review of literature has highlighted the lacunae and areas of dissonance both in the literature and in clinical practice in relation to the critical care trajectory as experienced by survivors of critical illness and their families. RELEVANCE TO CLINICAL PRACTICE Critical care nurses can and should play a role in preparing and supporting patients and families beyond the critical care unit. In turn, Registered Nurses needed to be supported to fulfil this important role in enabling the process of moving patients and their families from surviving to thriving (survivorship).
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Svenningsen H. A shared language regarding sedation and delirium in critically ill patients. Nurs Crit Care 2015; 20:204-9. [PMID: 25943474 DOI: 10.1111/nicc.12187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients in intensive care units who develop delirium, experience longer stay in intensive care as well as increased morbidity and mortality. A questionnaire in 2009 showed that there was no consensus in Denmark regarding the tools to be used to assess sedation or delirium, the patient groups they should be used in, or the frequency of assessment. AIMS The aims of this survey were to describe clinical practice regarding the assessment of sedation and delirium in intensive care patients and to compare the results with those obtained in 2009. METHOD A questionnaire was sent via e-mail to all intensive care units in Denmark caring for ventilated adult patients. An intensive care nurse with daily patient contact was asked to answer questions about the unit's practice regarding the tools used to assess sedation and delirium in adult patients. RESULTS In all, 98% of the intensive care units responded. Richmond Agitation-Sedation Scale was the most used tool for sedation assessment, and Confusion Assessment Method for the Intensive Care Unit was used only for delirium assessment. CONCLUSION A shared language for sedation and delirium assessment was identified as essential in supporting care delivery. RELEVANCE TO CLINICAL PRACTICE A systematic use of a shared language according to sedation and delirium in intensive care units can minimize mistakes in transfer of patients and minimize the risk of doubly traumatising patients.
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Affiliation(s)
- Helle Svenningsen
- H. Svenningsen, CCRN, MCN, PhD, Department of Nursing, VIA University College, Faculty of Health Sciences, Aarhus N, Denmark
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Svenningsen H, Langhorn L, Ågård AS, Dreyer P. Post-ICU symptoms, consequences, and follow-up: an integrative review. Nurs Crit Care 2015; 22:212-220. [DOI: 10.1111/nicc.12165] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/09/2014] [Accepted: 01/15/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Helle Svenningsen
- Lecturer, Department of Nursing, Faculty of Health Sciences, VIA University College; DK-8200 Aarhus N Denmark
| | - Leanne Langhorn
- Clinical Nurse Specialist, Aarhus University Hospital, Department of Neurosurgery NK; Dk-8000 Aarhus C Denmark
| | - Anne Sophie Ågård
- Clinical Nurse Specialist, Aarhus University Hospital, Department of Anaesthesiology and Intensive Care; DK-8200 Aarhus N Denmark
| | - Pia Dreyer
- Clinical Nurse Specialist, Associated Professor, Aarhus University, Department of Public Health, Section of Nursing Science, Aarhus University Hospital, Department of Anaesthesia and Intensive Care Medicine; Dk-8000 Aarhus C Denmark
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Wolters AE, van Dijk D, Pasma W, Cremer OL, Looije MF, de Lange DW, Veldhuijzen DS, Slooter AJC. Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study. Crit Care 2014; 18:R125. [PMID: 24942154 PMCID: PMC4095683 DOI: 10.1186/cc13929] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 06/04/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Delirium is associated with impaired outcome, but it is unclear whether this relationship is limited to in-hospital outcomes and whether this relationship is independent of the severity of underlying conditions. The aim of this study was to investigate the association between delirium in the intensive care unit (ICU) and long-term mortality, self-reported health-related quality of life (HRQoL), and self-reported problems with cognitive functioning in survivors of critical illness, taking severity of illness at baseline and throughout ICU stay into account. METHODS A prospective cohort study was conducted. We included patients who survived an ICU stay of at least a day; exclusions were neurocritical care patients and patients who sustained deep sedation during the entire ICU stay. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM-ICU) and additionally, patients who received haloperidol were considered delirious. Twelve months after ICU admission, data on mortality were obtained and HRQoL and cognitive functioning were measured with the European Quality of Life - Six dimensions self-classifier (EQ-6D). Regression analyses were used to assess the associations between delirium and the outcome measures adjusted for gender, type of admission, the Acute Physiology And Chronic Health Evaluation IV (APACHE IV) score, and the cumulative Sequential Organ Failure Assessment (SOFA) score throughout ICU stay. RESULTS Of 1101 survivors of critical illness, 412 persons (37%) had been delirious during ICU stay, and 198 (18%) died within twelve months. When correcting for confounders, no significant association between delirium and long-term mortality was found (hazard ratio: 1.26; 95% confidence interval (CI) 0.93 to 1.71). In multivariable analysis, delirium was not associated with HRQoL either (regression coefficient: -0.04; 95% CI -0.10 to 0.01). Yet, delirium remained associated with mild and severe problems with cognitive functioning in multivariable analysis (odds ratios: 2.41; 95% CI 1.57 to 3.69 and 3.10; 95% CI 1.10 to 8.74, respectively). CONCLUSIONS In this group of survivors of critical illness, delirium during ICU stay was not associated with long-term mortality or HRQoL after adjusting for confounding, including severity of illness throughout ICU stay. In contrast, delirium appears to be an independent risk factor for long-term self-reported problems with cognitive functioning.
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