1
|
Ayanaw Eyayu R, Gudayu Zeleke T, Chekol WB, Yaregal Melesse D, Enyew Ashagrie H. Assessment of level of knowledge, attitude, and associated factors toward delirium among health professionals working in intensive care unit multicenter, cross-sectional study, Amhara region comprehensive specialized hospitals, Northwest Ethiopia, 2023. Front Public Health 2024; 12:1338760. [PMID: 38510361 PMCID: PMC10951067 DOI: 10.3389/fpubh.2024.1338760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/30/2024] [Indexed: 03/22/2024] Open
Abstract
Background Patients in Intensive Care Unit (ICU) are at high risk of developing delirium. Lack of early detection and the inability to provide prompt management of delirium remain challenges of ICU patient care. This study aimed to assess the level of knowledge, attitude, and associated factors toward delirium among healthcare providers working in ICU. Methods A multicenter, cross-sectional survey was conducted in comprehensive specialized hospitals from 15 April to 5 June 2023. Data were collected using a pretested, self-administered questionnaire. Ordinal logistic regression analysis was performed at p < 0.05 with a 95% confidence interval (CI). The odds ratio with 95% CI was calculated to determine the strength of the association between independent and outcome variables. Results A total of 202 health professionals were included in this study, with a response rate of 87%. The proportions of good, moderate, and poor knowledge about delirium in ICU were 29.21 (95% CI: 23-36), 52.48 (95% CI: 45.3-59.5) and 18.32 (95% CI:13.2-24.4), respectively. The overall proportion of negative, neutral and positive attitude were 13.9 (95% CI: 9.4-19.4), 65.8 (95% CI: 58.9-72.4) and 20.3 (95% CI: 15-26.5) respectively. Being an anesthetist and exposure to training were positively associated with a good knowledge while belief in screening tool to change care and reading, and using guidelines were positively associated with a positive attitude. However, believing the impossibility of changing the practice of delirium care, and negative attitudes were delaying factors for a good knowledge. Also, workload and poor knowledge were hindering factors for a positive attitude. Conclusion More than half of health professionals had moderate knowledge and neutral attitude toward delirium. However, some of them had poor knowledge and a negative attitude. We recommend stakeholders prepare regular training for delirium care. Also, we urge health professionals to update themselves by reading guidelines and to use screening protocols for delirium.
Collapse
Affiliation(s)
| | | | | | | | - Henos Enyew Ashagrie
- Department of Anaesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
2
|
Baluku Murungi E, Niyonzima V, Atuhaire E, Nantume S, Beebwa E. Improving Nurses Knowledge and Practices of Delirium Assessment at Mbarara Regional Referral Hospital: A Quasi Experimental Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:313-322. [PMID: 37020902 PMCID: PMC10069436 DOI: 10.2147/amep.s398606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Despite the recommendations for delirium assessment in clinical settings, it stills remain a serious clinical problem associated with prolonged mechanical ventilation, stress on the patient and family, and mortality. There is paucity of data regarding delirium assessment and prevention in developing world. The Confusion Assessment Method for Intensive Care Unit (CAM-ICU) was developed to aid in the assessment of delirium. There is no documented assessment of delirium and prevention in Uganda. This study evaluated the effect of an educational intervention on nurses' knowledge and practices of delirium assessment using the CAM-ICU tool. METHODS We used a quasi-experimental and recruited a convenience sample of 29 nurses from ICU and ER. The assessment before and after the interventions was conducted using a self-completed questionnaire from October 2020 to January 2021. The interventions were delivered through face-to-face presentations, demonstrations, watching videos, and hands on practice. Data were entered into excel, cleaned and exported to Stata version 14. Median and interquartile ranges were used for continuous variables, and frequencies and percentages for categorical variables. The mean knowledge score was calculated before and after the intervention. A paired t-test was used to compare Pre- and Post-test knowledge and practice scores at P <0.05. RESULTS Majority (62%) were female, 48% were Diploma holders, median age was 30 (IQR = 28-32) years and median years of experience 3.5 (IQR = 3-4). The Mean knowledge scores was 10.7 (SD = 2.36) pretest and 19 (0.94) posttest. The mean practice score was 2 (SD = 0.83) pretest and 6 (0.35) posttest. There were significant differences in mean knowledge and practice scores before and after intervention mean of (t (28) =17.32, p < 0.001) and (t (28) = 25.04, p<0.001), respectively. CONCLUSION Educational intervention Improved nurses' knowledge and practice of delirium assessment. Continuous nursing education could improve nurses' knowledge of delirium assessment and thus quality of patient care.
Collapse
Affiliation(s)
- Eric Baluku Murungi
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Vallence Niyonzima
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Evas Atuhaire
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Susan Nantume
- Masaka School of Comprehensive Nursing, Masaka City, Uganda
| | - Esther Beebwa
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda
| |
Collapse
|
3
|
Ormseth CH, LaHue SC, Oldham MA, Josephson SA, Whitaker E, Douglas VC. Predisposing and Precipitating Factors Associated With Delirium: A Systematic Review. JAMA Netw Open 2023; 6:e2249950. [PMID: 36607634 PMCID: PMC9856673 DOI: 10.1001/jamanetworkopen.2022.49950] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Despite discrete etiologies leading to delirium, it is treated as a common end point in hospital and in clinical trials, and delirium research may be hampered by the attempt to treat all instances of delirium similarly, leaving delirium management as an unmet need. An individualized approach based on unique patterns of delirium pathophysiology, as reflected in predisposing factors and precipitants, may be necessary, but there exists no accepted method of grouping delirium into distinct etiologic subgroups. OBJECTIVE To conduct a systematic review to identify potential predisposing and precipitating factors associated with delirium in adult patients agnostic to setting. EVIDENCE REVIEW A literature search was performed of PubMed, Embase, Web of Science, and PsycINFO from database inception to December 2021 using search Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, and disease susceptibility, with constraints of cohort or case-control studies. Two reviewers selected studies that met the following criteria for inclusion: published in English, prospective cohort or case-control study, at least 50 participants, delirium assessment in person by a physician or trained research personnel using a reference standard, and results including a multivariable model to identify independent factors associated with delirium. FINDINGS A total of 315 studies were included with a mean (SD) Newcastle-Ottawa Scale score of 8.3 (0.8) out of 9. Across 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients) represented (24 015 with delirium), studies reported 33 predisposing and 112 precipitating factors associated with delirium. There was a diversity of factors associated with delirium, with substantial physiological heterogeneity. CONCLUSIONS AND RELEVANCE In this systematic review, a comprehensive list of potential predisposing and precipitating factors associated with delirium was found across all clinical settings. These findings may be used to inform more precise study of delirium's heterogeneous pathophysiology and treatment.
Collapse
Affiliation(s)
- Cora H. Ormseth
- Department of Emergency Medicine, University of California, San Francisco
| | - Sara C. LaHue
- Department of Neurology, University of California, San Francisco
| | - Mark A. Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | | | - Evans Whitaker
- University of California, San Francisco, School of Medicine
| | - Vanja C. Douglas
- Department of Neurology, University of California, San Francisco
| |
Collapse
|
4
|
Fu Z, Xu Q, Zhang C, Bai H, Chen X, Zhang Y, Luo W, Lin G. Admission Systolic Blood Pressure Predicts Post-Operative Delirium of Acute Aortic Dissection Patients in the Intensive Care Unit. Int J Gen Med 2021; 14:5939-5948. [PMID: 34584446 PMCID: PMC8464373 DOI: 10.2147/ijgm.s329689] [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: 07/16/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Post-operative delirium (POD) is a common complication after aortic surgery with poor outcomes. Blood pressure may play a role in the occurrence of POD. The study aimed to identify whether admission systolic blood pressure (SBP) level in the intensive care unit (ICU) is correlated with POD in acute Stanford type A aortic dissection (AAAD) patients undergoing aortic surgery. Patients and Methods We conducted a single-center retrospective cohort study enrolling consecutive 205 patients with acute type A aortic dissection undergoing aortic surgery. Patients were divided into 3 groups: low, normal, and high SBP level group. Outcomes of interest were POD, 30-day mortality and other complications including acute kidney injury, cardiac complications, spinal cord ischemia, stroke, and pneumonia. Confusion Assessment Method for Intensive Care Unit (CAM-ICU) method was used to assess POD. Univariate and multivariate logistic regression, Cox regression, and subgroup analysis were performed to uncover the association between SBP and POD. Results The mean age of these patients was 51±16 years old. Thirty-six patients (17.6%) developed POD. Patients with high admission SBP were more likely to develop POD (P < 0.01). Univariate analysis showed that high admission SBP was associated with a higher risk of POD among AAAD patients (OR, 3.514; 95% CI, 1.478-8.537, P < 0.01). Multivariate logistic regression model confirmed that high SBP was an independent predictor of POD. Subgroup analysis indicated that patients with anemia and high admission SBP were at higher risk of POD. Conclusion High admission SBP was positively associated with the incidence of POD in AAAD patients who underwent surgical repair in ICU.
Collapse
Affiliation(s)
- Zuli Fu
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Qian Xu
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Chiyuan Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Hui Bai
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xuliang Chen
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yanfeng Zhang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Wanjun Luo
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Guoqiang Lin
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| |
Collapse
|
5
|
Risk factors for delirium among hospitalized patients in Zambia. PLoS One 2021; 16:e0249097. [PMID: 33831010 PMCID: PMC8031188 DOI: 10.1371/journal.pone.0249097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/08/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To identify risk factors for delirium among hospitalized patients in Zambia. Methods We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. We report associations of exposures including sociodemographic and clinical factors with delirium over the first three days of hospital admission, assessed using a modified Brief Confusion Assessment Method (bCAM). Findings 749 patients were included for analysis (mean age, 42.9 years; 64.8% men; 47.3% with HIV). In individual regression analyses of potential delirium risk factors adjusted for age, sex and education, factors significantly associated with delirium included being divorced/widowed (OR 1.64, 95% CI 1.09–2.47), lowest tercile income (OR 1.58, 95% CI 1.04–2.40), informal employment (OR 1.97, 95% CI 1.25–3.15), untreated HIV infection (OR 2.18, 95% CI 1.21–4.06), unknown HIV status (OR 2.90, 95% CI 1.47–6.16), history of stroke (OR 2.70, 95% CI 1.15–7.19), depression/anxiety (OR 1.52, 95% CI 1.08–2.14), alcohol overuse (OR 1.96, 95% CI 1.39–2.79), sedatives ordered on admission (OR 3.77, 95% CI 1.70–9.54), severity of illness (OR 2.00, 95% CI 1.82–2.22), neurological (OR 7.66, 95% CI 4.90–12.24) and pulmonary-system admission diagnoses (OR 1.91, 95% CI 1.29–2.85), and sepsis (OR 2.44, 95% CI 1.51–4.08). After combining significant risk factors into a multivariable regression analysis, severity of illness, history of stroke, and being divorced/widowed remained predictive of delirium (p<0.05). Conclusion Among hospitalized adults at a national referral hospital in Zambia, severity of illness, history of stroke, and being divorced/widowed were independently predictive of delirium. Extension of this work will inform future efforts to prevent, detect, and manage delirium in low- and middle-income countries.
Collapse
|
6
|
Banerdt JK, Mateyo K, Wang L, Lindsell CJ, Riviello ED, Saylor D, Heimburger DC, Ely EW. Delirium as a predictor of mortality and disability among hospitalized patients in Zambia. PLoS One 2021; 16:e0246330. [PMID: 33571227 PMCID: PMC7877643 DOI: 10.1371/journal.pone.0246330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/18/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To study the epidemiology and outcomes of delirium among hospitalized patients in Zambia. METHODS We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. The primary exposure was delirium duration over the initial 3 days of hospitalization, assessed daily using the Brief Confusion Assessment Method. The primary outcome was 6-month mortality. Secondary outcomes included 6-month disability, evaluated using the World Health Organization Disability Assessment Schedule 2.0. FINDINGS 711 adults were included (median age, 39 years; 461 men; 459 medical, 252 surgical; 323 with HIV). Delirium prevalence was 48.5% (95% CI, 44.8%-52.3%). 6-month mortality was higher for delirious participants (44.6% [39.3%-50.1%]) versus non-delirious participants (20.0% [15.4%-25.2%]; P < .001). After adjusting for covariates, delirium duration independently predicted 6-month mortality and disability with a significant dose-response association between number of days with delirium and odds of worse clinical outcome. Compared to no delirium, presence of 1, 2 or 3 days of delirium resulted in odds ratios for 6-month mortality of 1.43 (95% CI, 0.73-2.80), 2.20 (1.07-4.51), and 3.92 (2.24-6.87), respectively (P < .001). Odds of 6-month disability were 1.20 (0.70-2.05), 1.73 (0.95-3.17), and 2.80 (1.78-4.43), respectively (P < .001). CONCLUSION Among hospitalized medical and surgical patients in Zambia, delirium prevalence was high and delirium duration independently predicted mortality and disability at 6 months. This work lays the foundation for prevention, detection, and management of delirium in low-income countries. Long-term follow up of outcomes of critical illness in resource-limited settings appears feasible using the WHO Disability Assessment Schedule.
Collapse
Affiliation(s)
- Justin K. Banerdt
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Kondwelani Mateyo
- University of Zambia School of Medicine, Lusaka, Zambia
- University Teaching Hospital, Lusaka, Zambia
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Christopher J. Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Elisabeth D. Riviello
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Deanna Saylor
- University of Zambia School of Medicine, Lusaka, Zambia
- University Teaching Hospital, Lusaka, Zambia
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Douglas C. Heimburger
- University of Zambia School of Medicine, Lusaka, Zambia
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America
| | - E. Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, United States of America
| |
Collapse
|
7
|
Jin T, Jin Y, Lee SM. Medication Use and Risk of Delirium in Mechanically Ventilated Patients. Clin Nurs Res 2019; 30:474-481. [PMID: 31466469 DOI: 10.1177/1054773819868652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
One of the principal complications in patients in the intensive care unit, particularly in those receiving mechanical ventilation, is medication-induced delirium. The present study aimed to intensively analyze pharmaceutical factors affecting the development of delirium in mechanically ventilated patients using the electronic health records. The present study was designed as a retrospective case-control study. The delirium group included 500 mechanically ventilated patients. The non-delirium group included 2,000 patients who were hospitalized during the same period as the delirium group and received mechanical ventilation. A total of seven types of medications (narcotic analgesics, non-narcotic analgesics, psychopharmaceuticals, sleep aid medications, anticholinergics, steroids, and diuretics), conventionally used to manage mechanical ventilation, were found to be major risk factors associated with the occurrence of delirium. Since these medications are an integral part of managing mechanically ventilated patients, prudent protocol-based medication approaches are essential to decrease the risk of delirium.
Collapse
Affiliation(s)
- Taixian Jin
- The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Sun-Mi Lee
- The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
8
|
Sosa FA, Roberti J, Franco MT, Kleinert MM, Patrón AR, Osatnik J. Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina. Rev Bras Ter Intensiva 2018; 30:50-56. [PMID: 29742219 PMCID: PMC5885231 DOI: 10.5935/0103-507x.20180010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/03/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe the incidence of and risk factors for delirium in the intensive care unit of a tertiary care teaching hospital in Argentina and to conduct the first non-European study exploring the performance of the PREdiction of DELIRium in ICu patients (PRE-DELIRIC) model. METHODS Prospective observational study in a 20-bed intensive care unit of a tertiary care teaching hospital in Buenos Aires, Argentina. The PRE-DELIRIC model was applied to 178 consecutive patients within 24 hours of admission to the intensive care unit; delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). RESULTS The mean age was 64.3 ± 17.9 years. The median time of stay in the intensive care unit was 6 (range, 2 - 56) days. Of the total number of patients, 49/178 (27.5%) developed delirium, defined as a positive CAM-ICU assessment, during their stay in the intensive care unit. Patients in the delirium group were significantly older and had a significantly higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score. The mortality rate in the intensive care unit was 14.6%; no significant difference was observed between the two groups. Predictive factors for the development of delirium were increased age, prolonged intensive care unit stay, and opioid use. The area under the curve for the PRE-DELIRIC model was 0.83 (95%CI; 0.77 - 0.90). CONCLUSIONS The observed incidence of delirium highlights the importance of this problem in the intensive care unit setting. In this first study conducted outside Europe, PRE-DELIRIC accurately predicted the development of delirium.
Collapse
Affiliation(s)
| | - Javier Roberti
- Unidade de Terapia Intensiva, Hospital Alemán, Buenos Aires, Argentina
| | | | | | | | - Javier Osatnik
- Unidade de Terapia Intensiva, Hospital Alemán, Buenos Aires, Argentina
| |
Collapse
|