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Lapierre A, Proulx A, Gélinas C, Dollé S, Alexander S, Williamson D, Bernard F, Arbour C. Association Between Pupil Light Reflex and Delirium in Adults With Traumatic Brain Injury: Preliminary Findings. J Neurosci Nurs 2024; 56:107-112. [PMID: 38833515 DOI: 10.1097/jnn.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
ABSTRACT BACKGROUND: Delirium is a common neurological complication in patients admitted to the intensive care unit (ICU) after moderate to severe traumatic brain injury (TBI). Although current clinical guidelines prioritize delirium prevention, no specific tool is tailored to detect early signs of delirium in TBI patients. This preliminary 2-phase observational study investigated the correlation between the pupillary light reflex (PLR), measured with a pupillometer during mechanical ventilation, and the development of postextubation delirium in TBI patients. METHODS: A convenience sample of 26 adults with moderate to severe TBI under mechanical ventilation was recruited during their ICU stay. In phase I, PLR measurements were performed in the first 3 days of ICU admission using automated infrared pupillometry. In phase II, 2 raters independently extracted delirium data in the 72 hours post extubation period from medical records. Delirium was confirmed with a documented medical diagnosis. Point-biserial correlations ( rpb ) were used to examine the association between PLR scores and the presence of postextubation delirium. Student t tests were also performed to compare mean PLR scores between patients with and without delirium. RESULTS: Ten TBI patients (38%) were diagnosed with postextubation delirium, whereas 16 (62%) were not. Significant correlations between delirium and 2 PLR variables were found: pupil constriction percentage ( rpb (24) = -0.526, P = .006) and constriction velocity ( rpb (24) = -0.485, P = .012). The t test also revealed a significant difference in constriction percentage and velocity scores between TBI patients with and without delirium ( P ≤ .01). CONCLUSION: Our findings suggest that the use of pupillometry in the first 3 days of mechanical ventilation during an ICU stay may help identify TBI patients at risk for delirium after extubation. Although further research is necessary to support its validity, this technological tool may enable ICU nurses to better screen TBI patients for delirium and prevent its development.
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Anis A, Patel R, Tanios MA. Analytical Review of Unplanned Extubation in Intensive Care Units and Recommendation on Multidisciplinary Preventive Approaches. J Intensive Care Med 2024; 39:507-513. [PMID: 37670719 DOI: 10.1177/08850666231199055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Unplanned extubations (UE) frequently occur in critical care units. These events are precipitated by many risk factors and are associated with adverse outcomes for patients. We reviewed the current literature to examine factors related to UE and presented the analysis of 41 articles critical to the topic. Our review has identified specific risk factors that we discuss in this review, such as sedation strategies, physical restraints, endotracheal tube position, and specific nursing care aspects associated with an increased incidence of UE. We recommend interventions to reduce the risk of UE. However, we recommend that bundled rather than a single intervention is likely to yield higher success, given the heterogeneity of factors contributing to increasing the risk of UE.
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Affiliation(s)
- Antonious Anis
- Internal Medicine Residency Program, St. Mary Medical Center, Long Beach, CA, USA
- Critical Care Medicine Fellowship, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ravi Patel
- Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, CA, USA
| | - Maged A Tanios
- Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, CA, USA
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Fernandes F, Santos M, Anacleto AM, Jerónimo C, Ferreira Ó, Baixinho CL. Nursing Intervention to Prevent and Manage Delirium in Critically Ill Patients: A Scoping Review. Healthcare (Basel) 2024; 12:1134. [PMID: 38891209 PMCID: PMC11172012 DOI: 10.3390/healthcare12111134] [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: 04/29/2024] [Revised: 05/19/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Delirium is an acute neuropsychiatric syndrome of multifactorial etiology with a high incidence in people admitted to intensive care units. In addition to reversible impairment of cognitive processes, it may be associated with changes in thinking and perception. If, in the past, it was considered an expected complication of severe disease, nowadays, delirium is associated with a poor short-term and long-term prognosis. Knowing that its prevention and early identification can reduce morbidity, mortality, and health costs, it is vital to investigate nursing interventions focused on delirium in critically ill patients. This study aimed to identify nursing interventions in the prevention and management of delirium in critically ill adults. The method used to answer the research question was a scoping review. The literature search was performed in the Medline (via PubMed), CINAHL (via EBSCOhost), Scopus, Web of Science, and JBI databases. The final sample included 15 articles. Several categories of non-pharmacological interventions were identified, addressing the modifiable risk factors that contribute to the development of delirium, and for which nurses have a privileged position in their minimization. No drug agent can, by itself, prevent or treat delirium. However, psychoactive drugs are justified to control hyperactive behaviors through cautious use. Early diagnosis, prevention, or treatment can reduce symptoms and improve the individual's quality of life. Therefore, nursing professionals must ensure harmonious coordination between non-pharmacological and pharmacological strategies.
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Affiliation(s)
- Filipa Fernandes
- Hospital de Vila Franca de Xira, 2600-009 Vila Franca de Xira, Portugal; (F.F.); (A.M.A.); (C.J.)
| | | | - Ana Margarida Anacleto
- Hospital de Vila Franca de Xira, 2600-009 Vila Franca de Xira, Portugal; (F.F.); (A.M.A.); (C.J.)
| | - Cátia Jerónimo
- Hospital de Vila Franca de Xira, 2600-009 Vila Franca de Xira, Portugal; (F.F.); (A.M.A.); (C.J.)
| | - Óscar Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal;
| | - Cristina Lavareda Baixinho
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal;
- Center of Innovative Care and Health Technology (ciTechCare), 2414-016 Leiria, Portugal
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Kuo FH, Tudor BH, Gray GM, Ahumada LM, Rehman MA, Watkins SC. Precision Anesthesia in 2050. Anesth Analg 2024; 138:326-336. [PMID: 38215711 DOI: 10.1213/ane.0000000000006688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Over the last few decades, the field of anesthesia has advanced far beyond its humble beginnings. Today's anesthetics are better and safer than ever, thanks to innovations in drugs, monitors, equipment, and patient safety.1-4 At the same time, we remain limited by our herd approach to medicine. Each of our patients is unique, but health care today is based on a one-size-fits-all approach, while our patients grow older and more medically complex every year. By 2050, we believe that precision medicine will play a central role across all medical specialties, including anesthesia. In addition, we expect that health care and consumer technology will continually evolve to improve and simplify the interactions between patients, providers, and the health care system. As demonstrated by 2 hypothetical patient experiences, these advancements will enable more efficient and safe care, earlier and more accurate diagnoses, and truly personalized treatment plans.
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Affiliation(s)
| | - Brant H Tudor
- Center for Pediatric Data Science and Analytic Methodology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Geoffrey M Gray
- Center for Pediatric Data Science and Analytic Methodology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Luis M Ahumada
- Center for Pediatric Data Science and Analytic Methodology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
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Warner RL, Iwanyshyn N, Johnson D, Skarupa DJ. Optimization of Care for the Elderly Surgical Emergency Patient. Surg Clin North Am 2023; 103:1253-1267. [PMID: 37838466 DOI: 10.1016/j.suc.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Geriatric patients undergoing emergency surgery are at significantly higher risk for complications and death when compared with younger patients. Optimizing care for these patients requires a multidisciplinary team, special attention to physiologic changes and medication use, as well as targeted intervention to mitigate complications such as delirium, which can worsen overall outcomes. Frailty can be assessed preoperatively to identify patients at the highest risk for complications. Shared decision-making with both the family and patient during the consent process is integral to defining patient's goals of care in these high-risk situations.
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Affiliation(s)
- Rachel Lynne Warner
- University of Florida College of Medicine -Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Nadia Iwanyshyn
- University of Florida College of Pharmacy -Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Donald Johnson
- University of Florida College of Pharmacy -Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - David J Skarupa
- University of Florida College of Medicine -Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA.
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Koller-Ditto N. Identification and Best Practice Management of Comorbid Geri-Psych Conditions in Critical Care. Crit Care Nurs Clin North Am 2023; 35:481-493. [PMID: 37838420 DOI: 10.1016/j.cnc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Mental illnesses among critically ill patients are approximately 2.5 times that of the general population. Although older adults with physical-mental multimorbidity represent more than 50% of critical care admissions, health-care professionals caring for geriatric patients are not adequately educated to effectively recognize and treat serious mental illness. Additionally, critical care nurses feel vulnerable, unsupported, and unable to provide the best and safest possible patient-centered care for patients with mental illness. Hospitals can reduce these burdens by creating critical care policies and practices that are inclusive of geriatric and mental health concepts, care, and continuing education to those providing care.
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Affiliation(s)
- Noel Koller-Ditto
- Eastern Michigan University, College of Nursing, Ypsilanti, MI 48197, USA.
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Marcos-Vidal JM, González R, Merino M, Higuera E, García C. Sedation for Patients with Sepsis: Towards a Personalised Approach. J Pers Med 2023; 13:1641. [PMID: 38138868 PMCID: PMC10744994 DOI: 10.3390/jpm13121641] [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: 10/14/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
This article looks at the challenges of sedoanalgesia for sepsis patients, and argues for a personalised approach. Sedation is a necessary part of treatment for patients in intensive care to reduce stress and anxiety and improve long-term prognoses. Sepsis patients present particular difficulties as they are at increased risk of a wide range of complications, such as multiple organ failure, neurological dysfunction, septic shock, ARDS, abdominal compartment syndrome, vasoplegic syndrome, and myocardial dysfunction. The development of any one of these complications can cause the patient's rapid deterioration, and each has distinct implications in terms of appropriate and safe forms of sedation. In this way, the present article reviews the sedative and analgesic drugs commonly used in the ICU and, placing special emphasis on their strategic administration in sepsis patients, develops a set of proposals for sedoanalgesia aimed at improving outcomes for this group of patients. These proposals represent a move away from simplistic approaches like avoiding benzodiazepines to more "objective-guided sedation" that accounts for a patient's principal pathology, as well as any comorbidities, and takes full advantage of the therapeutic arsenal currently available to achieve personalised, patient-centred treatment goals.
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Affiliation(s)
- José Miguel Marcos-Vidal
- Department of Anesthesiology and Critical Care, Universitary Hospital of Leon, 24071 Leon, Spain; (R.G.); (M.M.); (E.H.); (C.G.)
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He J, Duan R, Qiu P, Zhang H, Zhang M, Liu M, Wu X, Li J. The risk factors of postoperative cognitive dysfunction in patients undergoing carotid endarterectomy: an updated meta-analysis. J Cardiothorac Surg 2023; 18:309. [PMID: 37946270 PMCID: PMC10636909 DOI: 10.1186/s13019-023-02428-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE The purpose of the current meta-analysis was to determine the incidence and risk factors to provide a scientific basis for prevention and treatment of postoperative cognitive dysfunction (POCD) after carotid endarterectomy (CEA). METHODS Relevant articles published before October 2022 were searched from Pubmed/MEDLINE, Cochrane and Embase databases. The outcomes were the incidence and risk factors for POCD. A random-effects model was applied to estimate the overall odds ratios (ORs) and mean differences (MDs) for all risk factors through STATA 14.0 and RevMan 5.4. The quality of eligible studies was evaluated by Newcastle-Ottawa Scale (NOS) as previously described. RESULTS A total of 22 articles involving 3459 CEA patients were finally identified. The weighted mean incidence of POCD was 19% (95% confidence intervals (95% CI) 0.16-0.24, P < 0.001). Of the 16 identified risk factors, hyperperfusion (OR: 0.54, 95% CI 0.41-0.71) and degree of internal carotid artery (ICA) stenosis (OR: 5.06, 95% CI 0.86-9.27) were the potential risk factors of POCD, whereas patients taking statins preoperative had a lower risk of POCD (OR: 0.54, 95% CI 0.41-0.71). Subgroup analysis revealed that the risk of POCD at 1 month after CEA was higher in patients with diabetes (OR: 1.70, 95% CI 1.07-2.71). CONCLUSION The risk factors of POCD were hyperperfusion and degree of ICA stenosis, while diabetes could significantly increase the incidence of POCD at 1 month after surgery. Additionally, preoperative statin use could be a protective factor for POCD following CEA.
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Affiliation(s)
- Jinhua He
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Ran Duan
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Peng Qiu
- Clinical Laboratory, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Meng Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Xiaoqian Wu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China.
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Guo R, Zhang S, Yu S, Li X, Liu X, Shen Y, Wei J, Wu Y. Inclusion of frailty improved performance of delirium prediction for elderly patients in the cardiac intensive care unit (D-FRAIL): A prospective derivation and external validation study. Int J Nurs Stud 2023; 147:104582. [PMID: 37672971 DOI: 10.1016/j.ijnurstu.2023.104582] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The elderly patients admitted to cardiac intensive care unit (CICU) are at relatively high risk for developing delirium. A simple and reliable predictive model can benefit them from early recognition of delirium followed by timely and appropriate preventive strategies. OBJECTIVE To explore the role of frailty in delirium prediction and develop and validate a delirium predictive model including frailty for elderly patients in CICU. DESIGN A prospective, observational cohort study. SETTINGS CICU at China-Japan Friendship Hospital from March 1, 2022 to August 25, 2022 (derivation cohort); CICU at Beijing Anzhen Hospital affiliated to Capital Medical University from March 14, 2023 to May 8, 2023 (external validation cohort). PARTICIPANTS A total of 236 and 90 participants were enrolled in the derivation and external validation cohorts, respectively. Participants in the derivation cohort were assigned into either the delirium (n = 70) or non-delirium group (n = 166) based on the occurrence of delirium. METHODS The simplified Chinese version of the Confusion Assessment Method for the Diagnosis of Delirium in the Intensive Care Unit was used to assess delirium twice a day at 8:00-10:00 and 18:00-20:00 until the onset of delirium or discharge from the CICU. Frailty was assessed using the FRAIL scale during the first 24 h in the CICU. Other possible risk factors were collected prospectively through patient interviews and medical records review. After processing missing data via multiple imputations, univariate analysis and bootstrapped forward stepwise logistic regression were performed to select optimal predictors and develop the models. The models were internally validated using bootstrapping and evaluated comprehensively via discrimination, calibration, and clinical utility in both the derivation and external validation cohorts. RESULTS The study developed D-FRAIL predictive model using FRAIL score, hearing impairment, Acute Physiology and Chronic Health Evaluation-II score, and fibrinogen. The area under the receiver operating characteristic curve (AUC) was 0.937 (95% confidence interval [CI]: 0.907-0.967) and 0.889 (95%CI: 0.840-0.938) even after bootstrapping in the derivation cohort. Inclusion of frailty was demonstrated to improve the model performance greatly with the AUC increased from 0.851 to 0.937 (p < 0.001). In the external validation cohort, the AUC of D-FRAIL model was 0.866 (95%CI: 0.782-0.907). Calibration plots and decision curve analysis suggested good calibration and clinical utility of the D-FRAIL model in both the derivation and external validation cohorts. CONCLUSIONS For elderly patients in the CICU, FRAIL score is an independent delirium predictor and the D-FRAIL model demonstrates superior performance in predicting delirium.
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Affiliation(s)
- Rongrong Guo
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Shan Zhang
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Saiying Yu
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Xiangyu Li
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Xinju Liu
- Cardiac Intensive Care Unit, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yanling Shen
- Surgical Intensive Care Unit, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jinling Wei
- Cardiac Intensive Care Unit, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing 100069, China.
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Kiliç G, Kav S. Effect of using eye masks and earplugs in preventing delirium in intensive care patients: A single-blinded, randomized, controlled trial. Nurs Crit Care 2023; 28:698-708. [PMID: 37138379 DOI: 10.1111/nicc.12901] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Delirium, which is frequently encountered in intensive care patients, can be prevented with multicomponent nursing interventions, and thus the negative consequences can be reduced. AIM To examine the effect of using eye masks and earplugs in preventing delirium in intensive care units (ICUs). STUDY DESIGN A randomized, controlled, single-blind intervention study. This study was conducted in the medical and surgical ICUs of a tertiary hospital, and nurses were given pre-study training on delirium risks, diagnosis, prevention, and management. Data were collected using the patient information form, the Nursing Delirium Screening Scale, the Richard-Campbell Sleep Scale, and the daily follow-up form. Various environmental modifications were made in the ICUs for all patients, and evidence-based nonpharmacological nursing interventions were applied to the patients in both groups during the day and night shifts for 3 days. In addition, the patients in the intervention group were provided with eye masks and earplugs for three nights. RESULTS The study included a total of 60 patients (30 in the intervention group and 30 in the control group). There was a statistically significant difference in the development of delirium between the intervention and control groups (night of the 2nd day, p = .019; day of the 3rd day p < .001; night of the 3rd day p ≤ .001). The average total sleep quality score of the intervention group was found to be significantly higher than the control group (p ≤ .001 for three nights). Staying in the internal medicine ICU affected (odds ratio [OR], 11.84; 95% confidence interval [CI], 3.00-46.66; p = .017) more on the development of delirium than in coronary ICU, being in the age group of 65 and over, having a hearing impairment, coming to ICU from the operating room, and education level had an effect. CONCLUSIONS The earplugs and eye masks used by the intensive care patients overnight were found to be effective in increasing sleep quality and preventing delirium. RELEVANCE TO CLINICAL PRACTICE The use of eye masks and earplugs is recommended for ICUs in preventing delirium.
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Affiliation(s)
- Gülşen Kiliç
- Baskent University Ankara Hospital, Internal Medicine Intensive Care Unit, Ankara, Turkey
| | - Sultan Kav
- Baskent University, Faculty of Health Sciences, Department of Nursing, Ankara, Turkey
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Kim DJ, Park YK, Kim KM, Kim SY, Jung JC, Chang HW, Lee JH, Kim JS, Lim C, Park KH. Improved clinical outcomes following introduction of an attending intensivist for patients admitted to the cardiac surgical intensive care unit after valvular heart surgery: a single-center experience. J Thorac Dis 2023; 15:4273-4284. [PMID: 37691679 PMCID: PMC10482617 DOI: 10.21037/jtd-23-581] [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: 04/06/2023] [Accepted: 07/10/2023] [Indexed: 09/12/2023]
Abstract
Background Although numerous studies have documented the improved clinical outcomes of patients undergoing cardiac surgery following introduction of attending intensivist, most of these studies included heterogeneous patient populations. We aimed to investigate the impact of an attending intensivist on the clinical outcomes of patients admitted to the cardiac surgical intensive care unit (CSICU) following valvular heart surgery. Methods Patients who underwent valvular heart surgery between January 2007 and December 2012 (control group, n=337) were propensity matched (1:1) between January 2013 and June 2017 (intensivist group, n=407). Results During the propensity score matching analysis, 285 patients were extracted from each group. Patients in the intensivist group underwent mechanical ventilation for a significantly shorter time than those in the control group (21.8±69.8 vs. 39.2±115.3 hours, P=0.021). More patients were extubated within 6 hours in the intensivist group than in the control group (53.7% vs. 42.8%, P=0.015). The incidence of ventilator-associated pneumonia (1.4% vs. 4.9%, P=0.031), cardiac arrest due to cardiac tamponade associated with post-cardiotomy bleeding (0.4% vs. 3.9%, P=0.002), and acute kidney injury (2.8% vs. 7.7%, P=0.011) in the intensivist group was significantly lower than that in the control group. The 30-day mortality rate of the intensivist group was significantly lower than that of the control group (2.1% vs. 6.7%, P=0.015). Conclusions Critical care provided in the CSICU staffed by an attending intensivist is associated with a lower 30-day mortality rate and reduced incidence of postoperative complications.
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Gil E, Zisberg A, Shadmi E, Gur-Yaish N, Shulyaev K, Chayat Y, Agmon M. Still WALKing-FOR: 2-year sustainability of the 'WALK FOR' intervention. Age Ageing 2023; 52:afad115. [PMID: 37390475 DOI: 10.1093/ageing/afad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND low mobility of hospitalised older adults is associated with adverse outcomes and imposes a significant burden on healthcare and welfare systems. Various interventions have been developed to reduce this problem; at present, however, their methodologies and outcomes vary and information is lacking about their long-term sustainability. This study aimed to evaluate the 2-year sustainability of the WALK-FOR (walking for better outcomes and recovery) intervention implemented by teams in acute care medical units. METHODS a quasi-experimental three-group comparative design (N = 366): pre-implementation, i.e. control group (n = 150), immediate post-implementation (n = 144) and 2-year post-implementation (n = 72). RESULTS mean participant age was 77.6 years (± 6 standard deviation [SD]) and 45.3% were females. We conducted an analysis of variance test to evaluate the differences in primary outcomes: number of daily steps and self-reported mobility. Levels of mobility improved significantly from the pre-implementation (control) group to the immediate and 2-year post-implementation groups. Daily step count: pre-implementation (median: 1,081, mean: 1,530 SD = 1,506), immediate post-implementation (median: 2,225, mean: 2,724. SD = 1,827) and 2-year post-implementation (median: 1,439, mean: 2,582, SD = 2,390) F = 15.778 P < 0.01. Self-reported mobility: pre-implementation (mean:10.9, SD = 3.5), immediate post-implementation (mean: 12.4, SD = 2.2), 2-year post-implementation (mean: 12.7, SD = 2.2), F = 16.250, P < 0.01. CONCLUSIONS the WALK-FOR intervention demonstrates 2-year sustainability. The theory-driven adaptation and reliance on local personnel produce an effective infrastructure for long-lasting intervention. Future studies should evaluate sustainability from a wider perspective to inform further in-hospital intervention development and implementation.
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Affiliation(s)
- Efrat Gil
- Haemek Medical Center, Afula, Israel
- Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa
| | - Nurit Gur-Yaish
- Faculty of Graduate Studies and Continuing Education , Oranim Academic College of Education, The Center for Research and Study of Aging, University of Haifa, Tivon, Israel
| | - Ksenya Shulyaev
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa
| | | | - Maayan Agmon
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa
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Renzi S, Gitti N, Piva S. Delirium in the intensive care unit: a narrative review. JOURNAL OF GERONTOLOGY AND GERIATRICS 2023. [DOI: 10.36150/2499-6564-n600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
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van Bochove-Waardenburg M, van der Jagt M, de Man-van Ginkel J, Ista E. Sustained adherence to a delirium guideline five years after implementation in an intensive care setting: A retrospective cohort study. Intensive Crit Care Nurs 2023; 76:103398. [PMID: 36731265 DOI: 10.1016/j.iccn.2023.103398] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To explore the level of sustained adherence to a delirium guideline in a university intensive care unit setting five years after cessation of a multifaceted implementation program conducted between April 2012 and February 2015. RESEARCH METHODOLOGY/DESIGN A quantitative retrospective cohort study was conducted using the medical records of all eligible patients admitted to the intensive care unit from November 2019 to February 2020. SETTING Four adult intensive care units in a university hospital. MAIN OUTCOME MEASURES Primary outcome is adherence to seven performance indicators indicated in the guideline being: light sedation days, mobilisation, physical therapy, analgesics use, delirium and sedation screening and avoiding benzodiazepines. Clinical patient outcomes such as Intensive care unit stay and prevalence of delirium were also collected. Data were compared with the results of the original implementation study's using descriptive statistics and Kruskal-wallis and Chi-square tests. RESULTS Data of 236 patients were included. The most notable decrease in adherence concerned 'number of light sedation days' (-28 %). Adherence to three indicators had increased: 'number of days receiving out-of-bed mobilisation' (+11 %); 'number of days receiving physical therapy' (+9%); and 'use of analgesics' (+12 %). Comparison of clinical outcomes showed an increased intensive care unit length-of-stay from 3 to 5 days (P < 0.001). Prevalence of delirium increased over five years from 41 % to 43 % of patients while delirium duration decreased from a median of 3 days to a median of 2 days. CONCLUSION Five years after ceasing of implementation efforts regarding the delirium guideline, partial sustainability has been achieved. The decrease in adherence to 'number of light sedation days' could have contributed to the increased length-of-stay on the intensive care unit. IMPLICATIONS FOR CLINICAL PRACTICE After implementation, routine monitoring of performance indicators is required to evaluate the level of sustainment. Further, revisiting reasons for decrease in guideline adherence when contextual changes occur. Reassessment of the perceived barriers and facilitators can guide adaptations to sustain, or even improve, adherence.
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Affiliation(s)
- Marlies van Bochove-Waardenburg
- Department of Intensive Care, Erasmus MC, Erasmus University Medical Center Rotterdam, The Netherlands; Department of Nursing Science, Program in Clinical Health Science, UMC Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus MC, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Janneke de Man-van Ginkel
- Department of Nursing Science, Program in Clinical Health Science, UMC Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Centre, The Netherlands
| | - Erwin Ista
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, The Netherlands; Department of Internal Medicine, Section Nursing Science, Erasmus MC, Erasmus University Medical Center Rotterdam, The Netherlands
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15
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Erbay Dalli Ö, Kelebek Girgin N, Kahveci F. Incidence, characteristics and risk factors of delirium in the intensive care unit: An observational study. J Clin Nurs 2023; 32:96-105. [PMID: 35639976 DOI: 10.1111/jocn.16197] [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: 10/05/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVE To investigate the incidence, characteristics and risk factors of delirium in the ICU. BACKGROUND Identifying the risk factors of delirium is important for early detection and to prevent adverse consequences. DESIGN An observational cohort study conducted according to STROBE Guidelines. METHOD The study was conducted with patients who stayed in ICU ≥24 h and were older than 18 years. Patients were assessed twice daily using the RASS and CAM-ICU until either discharge or death. Cumulative incidence was calculated. Demographic/clinical characteristics, length of stay and mortality were compared between patients with and without delirium. A logistic regression model was used to investigate risk factors. RESULTS The incidence of delirium was 31.8% and hypoactive type was the most frequent (41.5%). The median onset of delirium was 3 days (IQR = 2) with a mean duration of 5.27 ± 2.32 days. Patients with delirium were significantly older, had higher APACHE-II, SOFA and CPOT scores, higher blood urea levels, higher requirements for mechanical ventilation, sedation and physical restraints, longer stays in the ICU and higher mortality than those without delirium. The logistic regression analysis results revealed that a CPOT score ≥3 points (OR = 4.70, 95% CI: 1.05-20.93; p = .042), physical restraint (OR = 10.40, 95% CI: 2.75-39.27; p = .001) and ICU stay ≥7 days (OR = 7.26, 95% CI: 1.60-32.84; p = .010) were independent risk factors of delirium. CONCLUSIONS In this study, the incidence of delirium was high and associated with several factors. It is critical that delirium is considered by all members of the healthcare team, especially nurses, and that protocols are established for improvements. RELEVANCE TO THE CLINICAL PRACTICE Based on the results of this study, delirium could be decreased by preventing the presence of pain, prudent use of physical restraints and shortening the ICU stay.
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Affiliation(s)
- Öznur Erbay Dalli
- Division of Intensive Care, Department of Anesthesiology and Reanimation, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Nermin Kelebek Girgin
- Division of Intensive Care, Department of Anesthesiology and Reanimation, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ferda Kahveci
- Division of Intensive Care, Department of Anesthesiology and Reanimation, Uludag University Faculty of Medicine, Bursa, Turkey
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Tobita M, Fanchiang SP, Saldivar A, Taylor S, Jordan B. Complex Hallucinations in Hospitalized Rehabilitation Patients With COVID-19. Arch Rehabil Res Clin Transl 2022; 4:100234. [PMID: 36277732 PMCID: PMC9574548 DOI: 10.1016/j.arrct.2022.100234] [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] [Indexed: 12/14/2022] Open
Abstract
Objectives To explore the characteristics of hallucinations in hospitalized rehabilitation patients with COVID-19. Design Retrospective review using medical records of patients with COVID-19 and admitted to the acute inpatient rehabilitation unit (ARU). Setting A public hospital in southern California, specializing in rehabilitation medicine. Participants: Patients with COVID-19 and hallucinations who were consecutively admitted from January 1st to April 30th, 2021. Interventions Not applicable. Main Outcome Measures Types and themes of hallucinations. Results Eight of the 37 patients (21.6%) admitted to the ARU with COVID-19 exhibited hallucinations. All were Hispanic and 7 of them were men; their average age was 56.5 (range: 38-71). Seven patients had COVID-19 pneumonia and 1 developed respiratory distress secondary to Guillain-Barre Syndrome. One patient had posterior reversible encephalopathy syndrome. The average length of stay in the intensive care unit (ICU) was 31.3 days (range: 8-48). Most of the hallucinations occurred during their ICU stay and 2 continued to their ARU stay. All recalled details of hallucinations with 7 exhibiting visual hallucinations, consistent with peduncular hallucinosis with or without auditory and/or tactile components. One patient experienced tactile hallucinations. The themes of hallucinations identified to reflect the contents of the hallucinations were patients' comfort-seeking, fearfulness, and seeing deceased family members. All patients had impaired cognition at the ARU admission but improved at discharge. Four patients had depressed mood/anxiety and 1 had depressed mood alone but without a history of psychiatric illness. ICU delirium was documented in 5 patients. The negative experience of hallucinations seemed to affect their participation of the ARU stay. Conclusions More than 20% of patients with COVID-19 who were transferred to attend inpatient rehabilitation exhibited hallucinations. It remains uncertain if these hallucinations were related to the SARS-CoV-2 infection. Multidisciplinary rehabilitation team should be aware to support patients with COVID-19 who experience hallucinations.
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Affiliation(s)
- Mari Tobita
- Rancho Los Amigos National Rehabilitation Center, Department of Health Services, County of Los Angeles, Downey, CA,Rancho Research Institute, Downey, CA,Corresponding author Mari Tobita, MD, 7601 E Imperial Highway, Downey, CA 90242
| | - Shan-Pin Fanchiang
- Rancho Los Amigos National Rehabilitation Center, Department of Health Services, County of Los Angeles, Downey, CA,Rancho Research Institute, Downey, CA,Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Aida Saldivar
- Rancho Los Amigos National Rehabilitation Center, Department of Health Services, County of Los Angeles, Downey, CA
| | - Sarah Taylor
- Rancho Los Amigos National Rehabilitation Center, Department of Health Services, County of Los Angeles, Downey, CA
| | - Barry Jordan
- Rancho Los Amigos National Rehabilitation Center, Department of Health Services, County of Los Angeles, Downey, CA,Rancho Research Institute, Downey, CA,Department of Neurology, Keck Medicine of University of Southern California, Los Angeles, CA
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17
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Wojnar-Gruszka K, Sega A, Płaszewska-Żywko L, Wojtan S, Potocka M, Kózka M. Pain Assessment with the BPS and CCPOT Behavioral Pain Scales in Mechanically Ventilated Patients Requiring Analgesia and Sedation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10894. [PMID: 36078609 PMCID: PMC9517797 DOI: 10.3390/ijerph191710894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Intensive Care Unit (ICU) patients often experience pain, especially during diagnostic, nursing, and therapeutic interventions. Pain assessment using the Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CCPOT) are recommended, but they are difficult to do in patients undergoing deep sedation. This study analyzed the usefulness of the BPS and CCPOT scales in assessing pain among patients with varying degrees of sedation. METHODS In 81 mechanically ventilated and sedated ICU patients, 1005 measurements were performed using the BPS and CCPOT scales. The study was conducted by 3 trained observers 3 times a day (each measurement at rest, during painful nursing interventions, and after the intervention). The Richmond Agitation-Sedation Scale (RASS), the Simplified Acute Physiology Score (SAPS II), and the Acute Physiology and Chronic Health Evaluation (APACHE II) were also analyzed from medical records as well as information on the length of hospitalization and treatment. RESULTS It was shown that signs of pain increased significantly (p < 0.001) during interventions in patients on both scales (BPS and CCPOT), and then returned to values close to the resting period. RASS results correlated significantly (p < 0.05) and positively with the results of the BPS and CCPOT. A strong correlation was found between the results of both scales at each stage of the study (R = 0.622-0.907). CONCLUSIONS Nursing procedures are a source of pain in analgosedated patients. The BPS and CCPOT scales are useful tools for assessing the occurrence of pain in mechanically ventilated patients, including those in deep sedation.
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Affiliation(s)
- Katarzyna Wojnar-Gruszka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Aurelia Sega
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Lucyna Płaszewska-Żywko
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Stanisław Wojtan
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
- Department of Anaesthesiology and Intensive Therapy, University Hospital in Kraków, 30-688 Kraków, Poland
| | - Marcelina Potocka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Maria Kózka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
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Predictors of sedation period for critical illness patients focusing on early rehabilitation on the bed. Sci Rep 2022; 12:14092. [PMID: 35982206 PMCID: PMC9388676 DOI: 10.1038/s41598-022-18311-8] [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: 11/22/2021] [Accepted: 08/09/2022] [Indexed: 11/09/2022] Open
Abstract
There are various interventions of rehabilitation on the bed, but these are time-consuming and cannot be performed for all patients. The purpose of this study was to identify the patients who require early mobilization based on the level of sedation. We retrospectively evaluated the data of patients who underwent physical therapy, ICU admission of > 48 h, and were discharged alive. Sedation was defined as using sedative drugs and a Richmond Agitation-Sedation Scale score of < - 2. Multiple regression analysis was performed using sedation period as the objective variable, and receiver operating characteristic (ROC) curve and Spearman's rank correlation coefficient were performed. Of 462 patients admitted to the ICU, the data of 138 patients were analyzed. The Sequential Organ Failure Assessment (SOFA) score and non-surgery and emergency surgery cases were extracted as significant factors. The ROC curve with a positive sedation period of more than 3 days revealed the SOFA cutoff score was 10. A significant positive correlation was found between sedation period and the initial day on early mobilization. High SOFA scores, non-surgery and emergency surgery cases may be indicators of early mobilization on the bed in the ICU.
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Liu J, Li J, He J, Zhang H, Liu M, Rong J. The Age-adjusted Charlson Comorbidity Index predicts post-operative delirium in the elderly following thoracic and abdominal surgery: A prospective observational cohort study. Front Aging Neurosci 2022; 14:979119. [PMID: 36062155 PMCID: PMC9428551 DOI: 10.3389/fnagi.2022.979119] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background Post-operative delirium (POD) presents as a serious neuropsychiatric syndrome in the elderly undergoing thoracic and abdominal surgery, which is mostly associated with poor prognosis. The Age-adjusted Charlson Comorbidity Index (ACCI) has been widely recognized as an independently predictive factor for overall survival rate and mortality in various surgeries. However, no studies demonstrated the potential relationship between ACCI and POD. The current study was to explore the correlation between ACCI and POD, and determine the predictive effect of ACCI on POD in the elderly after thoracic and abdominal surgery. Materials and methods Total 184 patients (≥60 years) who underwent thoracic and abdominal surgery from 2021.10 to 2022.5 were enrolled in this prospective observational cohort study. ACCI was calculated by weighting comorbidities and age. POD was diagnosed using Confusion Assessment Method (CAM) twice a day in the first 3 days after surgery. The Visual Analog Scale (VAS) was applied to measure pre-operative and post-operative pain at rest and in motion. All demographic and perioperative data were compared in patients with POD and without POD. ACCI and other variables were analyzed by univariate and multivariate logistic regression analysis. The characteristic curve of receiver operating characteristic (ROC) was used to further evaluate the accuracy of ACCI to predict POD. Results Post-operative delirium was diagnosed in 36 of 184 patients included in our study. The prevalence of POD in the elderly after thoracic and abdominal surgery was 19.6%. The outcomes by multivariate regression analysis showed the independent risk factors for POD were ACCI (OR: 1.834; 95%CI: 1.434–2.344; P < 0.001), pre-operative Mini-Mental State Examination (MMSE) scores (OR: 0.873; 95%CI: 0.767–0.994; P = 0.040), serum albumin (OR: 0.909; 95%CI: 0.826–1.000; P = 0.049) and pain scores in the post-operative third day (OR: 2.013; 95%CI: 1.459–2.778; P < 0.001). ACCI can predict POD more accurately with the largest area under curve (AUC) of 0.794 and sensitivity of 0.861, respectively. Conclusion Age-adjusted Charlson Comorbidity Index, pre-operative MMSE scores, serum albumin and post-operative pain were independently associated with POD in geriatric patients following thoracic and abdominal surgery. Moreover, ACCI may become an accurate indicator to predict POD early.
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Affiliation(s)
- Jing Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
- Graduate Faculty, Hebei North University, Zhangjiakou, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
- *Correspondence: Jianli Li,
| | - Jinhua He
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Junfang Rong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
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The Effects of Pain, Agitation, Delirium, Immobility, and Sleep Disruption Education on Novice Nurses in Adult Intensive Care Units. Healthcare (Basel) 2022; 10:healthcare10081538. [PMID: 36011195 PMCID: PMC9408290 DOI: 10.3390/healthcare10081538] [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: 06/20/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
Intensive care unit (ICU) patients experience highly complex health problems, such as pain, agitation, delirium, immobility, and sleep disruption (PADIS), and require professional nursing care. The assessment of PADIS is critically important for ICU nurses, and therefore, PADIS education programs need to be conducted for these nurses to update and improve their caring knowledge, attitudes, and skills. The aims of this study are to bridge this gap by evaluating the effects of PADIS education programs on the knowledge, attitudes, and skills of these nurses, and compare the difference between novice and advanced nurses after receiving the PADIS education programs over a short period of time. In this quasi-experimental study, 112 nurses in ICUs were recruited by researchers and participated in the PADIS education programs. The PADIS education intervention was performed in a teaching hospital in Taipei. A demographic and self-developed PADIS care knowledge questionnaire was used. A baseline (T1) was measured before the interventions, followed by post-test (T2) immediately after the programs, and subsequently a follow-up (T3) test one month later. The results indicated that knowledge and skill scores between novice and advanced nurses varied significantly in T1 but not in T2 and T3. Thus, education programs can significantly assist novice ICU nurses to improve their short-term knowledge, attitudes, and skills, and PADIS education programs are strongly suggested for clinical nursing practice.
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21
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Oliveira C, Garnacho Martins Nobre CF, Dourado Marques RM, Madureira Lebre Mendes MM, Cruz Pontífice Sousa P. O papel do enfermeiro na prevenção do delirium no paciente adulto/idoso crítico. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.1983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introdução: Delirium é uma disfunção cerebral aguda, associado ao aumento da mortalidade e morbilidade, que atinge frequentemente o paciente adulto/idoso crítico. O enfermeiro tem um papel determinante na prevenção/controlo do delirium, através da implementação de intervenções não farmacológicas. Objetivo: Conhecer as intervenções de enfermagem na identificação, prevenção e controlo do delirium no paciente adulto/idoso crítico. Materiais e métodos: Realizada uma Revisão Integrativa da Literatura de artigos publicados entre 2014 e 2018, que identificaram intervenções de enfermagem dirigidas à prevenção e controlo do delirium no paciente adulto/idoso crítico. Foram realizadas quatro pesquisas, nas bases de dados electrónicas da EBSCOhost e na B-on. Resultados: Identificaram-se 13 estudos, que apresentam intervenções de enfermagem, maioritariamente não farmacológicas, para prevenção e controlo do delirium no paciente adulto/idoso crítico. Destas, evidenciam-se intervenções relacionadas com o ambiente, promoção do sono, intervenção terapêutica precoce, avaliação cognitiva e orientação dos pacientes, intervenções sistematizadas em protocolos, bem como intervenções direcionadas à participação dos familiares, à formação dos enfermeiros e ao ensino dos pacientes. Foram também identificados fatores de risco para o desenvolvimento do delirium e instrumentos de avaliação. Discussão: A prevenção do delirium é importante e imperativa, já que nos pacientes críticos a sua ocorrência está associada ao aumento da mortalidade, morbilidade, do tempo de internamento e a um elevado custo hospitalar. A identificação dos fatores de risco para a ocorrência do delirium devem estar incluídos nos protocolos de abordagem do delirium. Conclusão: As evidências demonstraram que o enfermeiro é fundamental na identificação precoce, prevenção e controlo do delirium, evitando a progressão da doença, contribuindo para a diminuição da morbilidade e mortalidade. A intervenção de enfermagem deve incluir a identificação de fatores predisponentes e/ou precipitantes de modo a contribuir para a diminuição da ocorrência e/ou resolução do quadro de delirium.
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Salottolo K, Meinig R, Fine L, Kelly M, Madayag R, Ekengren F, Tanner A, Bar-Or D. Associations of Smoking With Delirium and Opioid Use in Older Adults With Traumatic Hip Fracture. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e21.00188. [PMID: 35576240 PMCID: PMC10566843 DOI: 10.5435/jaaosglobal-d-21-00188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Cigarette smoking is a risk factor for hip fractures, while risk factors for developing delirium include older age and preexisting cognitive impairment. We sought to determine whether smoking status is independently associated with delirium and pain outcomes. METHODS This was a prospective, observational cohort study of 442 older adults (65 to 90 years) admitted for traumatic hip fracture at five trauma centers. The primary exposure was smoking status (n = 43, 10%). Additional risk factors included demographics, injury characteristics, and medical interventions. Delirium (primary) and analgesia-related complications were examined with multivariable logistic regression, while analysis of covariance models were used to examine preoperative and postoperative pain scores and opioid consumption (oral morphine equivalents). RESULTS Smokers had significantly worse outcomes compared with nonsmokers: delirium incidence was 16.3% versus 5.0% (adjusted odds ratio, 4.23; P = 0.005), analgesia complications developed in 30.2% versus 14.8% (adjusted odds ratio, 2.63; P = 0.01), and postoperative opioid consumption was greater (53 mg versus 33 mg, adjusted P = 0.04). Adjusted pain scores were not different between groups. DISCUSSION Smoking status is associated with markedly worse outcomes in older adults with traumatic hip fracture. Smoking status should be considered in pain management protocols and for early screening and delirium prevention methods. DATA AVAILABILITY On reasonable request.
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Affiliation(s)
- Kristin Salottolo
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Richard Meinig
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Landon Fine
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Michael Kelly
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Robert Madayag
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Francie Ekengren
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Allen Tanner
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - David Bar-Or
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
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23
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Bénézech JP. [Delirium, a poorly understood syndrome]. REVUE DE L'INFIRMIERE 2022; 71:42-43. [PMID: 35090632 DOI: 10.1016/j.revinf.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The word delirium is a more appropriate term than agitation or confusion to describe clinical realities that are common in intensive care units, postoperative units, geriatric units and palliative care units. Its recognition by carers will allow more appropriate care and treatment.
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Affiliation(s)
- Jean-Pierre Bénézech
- Centre hospitalier universitaire de Montpellier, hôpital Saint-Éloi, 80 avenue Augustin-Fliche, 34090 Montpellier, France.
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Lee H, Choi S, Jang EJ, Lee J, Kim D, Yoo S, Oh SY, Ryu HG. Effect of Sedatives on In-hospital and Long-term Mortality of Critically Ill Patients Requiring Extended Mechanical Ventilation for ≥ 48 Hours. J Korean Med Sci 2021; 36:e221. [PMID: 34463064 PMCID: PMC8405403 DOI: 10.3346/jkms.2021.36.e221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/22/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the correlation between sedatives and mortality in critically ill patients who required mechanical ventilation (MV) for ≥ 48 hours from 2008 to 2016. METHODS We conducted a nationwide retrospective cohort study using population-based healthcare reimbursement claims database. Data from adult patients (aged ≥ 18) who underwent MV for ≥ 48 hours between 2008 and 2016 were identified and extracted from the National Health Insurance Service database. The benzodiazepine group consisted of patients who were administered benzodiazepines for sedation during MV. All other patients were assigned to the non-benzodiazepine group. RESULTS A total of 158,712 patients requiring MV for ≥ 48 hours were admitted in 55 centers in Korea from 2008 to 2016. The benzodiazepine group had significantly higher in-hospital and one-year mortality compared to the non-benzodiazepine group (37.0% vs. 34.3%, 55.0% vs. 54.4%, respectively). Benzodiazepine use decreased from 2008 to 2016, after adjusting for age, sex, and mean Elixhauser comorbidity index in the Poisson regression analysis (incidence rate ratio, 0.968; 95% confident interval, 0.954-0.983; P < 0.001). Benzodiazepine use, older age, lower case volume (≤ 500 cases/year), chronic kidney disease, and higher Elixhauser comorbidity index were common significant risk factors for in-hospital and one-year mortality. CONCLUSION In critically ill patients undergoing MV for ≥ 48 hour, the use of benzodiazepines for sedation, older age, and chronic kidney disease were associated with higher in-hospital mortality and one-year mortality. Further studies are needed to evaluate the impact of benzodiazepines on the mortality in elderly patients with chronic kidney disease requiring MV for ≥ 48 hours.
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Affiliation(s)
- Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seongmi Choi
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, Korea
| | - Juhee Lee
- Department of Statistics, Kyungpook National University, Daegu, Korea
| | - Dalho Kim
- Department of Statistics, Kyungpook National University, Daegu, Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Young Oh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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25
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Lange S, Mędrzycka-Dąbrowska W, Friganovic A, Oomen B, Krupa S. Delirium in Critical Illness Patients and the Potential Role of Thiamine Therapy in Prevention and Treatment: Findings from a Scoping Review with Implications for Evidence-Based Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168809. [PMID: 34444556 PMCID: PMC8392497 DOI: 10.3390/ijerph18168809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Thiamine is a water-soluble vitamin and is necessary for energy metabolism. Critically ill patients are at particular risk of developing thiamine deficiency and related complications. One of the complications that can occur is delirium. Delirium is a disorder that affects the body's response to treatment, length of stay in the ward, mortality, long-term cognitive impairment, and significantly increases treatment costs. In addition, studies show that delirium medication is more effective in preventing than in treating delirium. Given its low cost, availability, and minimal risk of side effects, thiamine supplementation could prove to be a relevant strategy in the prevention and treatment of delirium. METHODS PubMed, Cochrane Library, Ovid, and ClinicalTrials.gov databases were searched using relevant keywords that focus on the use of thiamine to prevent or treat delirium in critically ill patients. RESULTS Seven articles were included in the analysis. CONCLUSION The small number of studies and considerable heterogeneity prevent conclusions supporting the use of thiamine as an adjuvant in the prevention and treatment of delirium among critically ill patients. There is a need for high-quality, large-scale randomized clinical trials to confirm the beneficial effects of thiamine in the prevention and treatment of delirium.
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Affiliation(s)
- Sandra Lange
- Department of Anesthesiology and Intensive Care, Hospitals Tczewskie SA, 83-110 Tczew, Poland;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdańsk, Poland
- Correspondence:
| | - Adriano Friganovic
- Department of Anesthesiology and Intensive Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia
| | - Ber Oomen
- European Specialist Nurses Organization (ESNO), 6821HR Arnhem, The Netherlands;
| | - Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-310 Rzeszow, Poland;
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Sinvani L, Delle Site C, Laumenede T, Patel V, Ardito S, Ilyas A, Hertz C, Wolf-Klein G, Pekmezaris R, Hajizadeh N, Thomas L. Improving delirium detection in intensive care units: Multicomponent education and training program. J Am Geriatr Soc 2021; 69:3249-3257. [PMID: 34402046 DOI: 10.1111/jgs.17419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Delirium is a common, devastating, and underrecognized syndrome in the intensive care unit (ICU). The study aimed to describe and evaluate a multicomponent education and training program utilizing a "Train-The-Trainer" (TTT) model, to improve delirium detection across a large health system. METHODS Fourteen ICUs across nine hospitals participated in a multicomponent delirium program consisting of a 1-day workshop that included: (1) patient testimonials, (2) small group discussions, (3) didactics, and (4) role-playing. Additionally, four ICUs received direct observation/training via telehealth (tele-delirium training). The Kirkpatrick model was used for program evaluation in a pre/post-test design. RESULTS A 1-day delirium workshop was held at two time points and included 73 ICU nurses. Of the 65 nurses completing the post-workshop satisfaction survey, most (46.2) had >10 years of clinical experience, and no or minimal delirium training (69.2%). All nurses (100%) identified lack of knowledge as a barrier to delirium detection, while time constraints and lack of importance accounted for only 25%. Overall, nurses rated the workshop positively (excellent 66.7%, and very good 23.3%), and likely to change practice (definitely 73.3% and very likely 15.0%). All validated Confusion Assessment Method for the ICU (CAM-ICU) cases demonstrated improvement in number of correct responses. Delirium detection across the health system improved from 9.1% at baseline to 21.2% in ICUs that participated in the workshop and 30.1% in those ICUs that also participated in the tele-delirium training (p = 0.005). CONCLUSION A multicomponent delirium education and training program using a TTT model was rated positively, improved CAM-ICU knowledge, and increased delirium detection.
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Affiliation(s)
- Liron Sinvani
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Division of Geriatrics and Palliative Medicine, Department of Medicine, Northwell Health, Manhasset, New York, USA.,Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York, USA
| | | | - Tara Laumenede
- Patient Care Services, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Vidhi Patel
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Suzanne Ardito
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Anum Ilyas
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Craig Hertz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Tele-Intensive Care Unit (eICU), Division of TeleHealth, Northwell Health, New Hyde Park, New York, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health, Manhasset, New York, USA
| | - Gisele Wolf-Klein
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Northwell Health, Manhasset, New York, USA
| | - Renee Pekmezaris
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Negin Hajizadeh
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health, Manhasset, New York, USA
| | - Lily Thomas
- Institute for Nursing, Northwell Health, New Hyde Park, New York, USA
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27
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Ho MH, Yu LF, Lin PH, Chang HCR, Traynor V, Huang WC, Montayre J, Chen KH. Effects of a simulation-based education programme on delirium care for critical care nurses: A randomized controlled trial. J Adv Nurs 2021; 77:3483-3493. [PMID: 34155687 DOI: 10.1111/jan.14938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/01/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022]
Abstract
AIMS To evaluate the effects of a simulation-based education programme on critical care nurses' knowledge, confidence, competence and clinical performance in providing delirium care. DESIGN Single-blinded randomized controlled trial. METHODS Registered nurses who work in intensive care units were recruited from a university-affiliated acute major metropolitan teaching hospital. The intervention group received: (i) five online-learning delirium care videos, (ii) one face-to-face delirium care education session and (iii) a simulation-based education programme with a role-play scenario-based initiative and an objective structured clinical examination. The control group received only online videos which were the same as those provided to the intervention group. Delirium care knowledge, confidence, competence, and clinical performance as outcomes were collected at: baseline, immediately after intervention, and within 6 weeks post-intervention to test whether there were any changes and if they were sustained over time. Data were collected between 2 October and 29 December 2020. The repeated-measures analysis of variance was used to examine for changes in delirium care knowledge, confidence, and competence within groups. RESULTS Seventy-two critical care nurses participated with 36 each allocated to the intervention group and control group. No statistically significant difference was observed between the two groups in outcome variables at 6 weeks post-intervention. In the intervention group, significant within-group changes were observed in terms of delirium care knowledge, confidence, and competence over time. By contrast, no significant changes were observed in outcome measures over time in the control group. CONCLUSION The simulation-based education programme is an effective and feasible strategy to improve delirium care by enhancing the knowledge, confidence, competence and clinical performance of critical care nurses. IMPACT Our findings provide evidence regarding the development and implementation of a simulation-based education programme in hospitals for health professional education in Taiwan.
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Affiliation(s)
- Mu-Hsing Ho
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, New South Wales, Australia.,Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Lee-Fen Yu
- Center for Nursing and Healthcare Research in Clinical Practice Application, Taipei Municipal Wanfang Hospital-Taipei Medical University, Taipei, Taiwan
| | - Pu-Hung Lin
- Department of Nursing, Taipei Municipal Wanfang Hospital-Taipei Medical University, Taipei, Taiwan
| | - Hui-Chen Rita Chang
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, New South Wales, Australia
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, New South Wales, Australia
| | - Wen-Cheng Huang
- Department of Emergency, Taipei Municipal Wanfang Hospital-Taipei Medical University, Taipei, Taiwan
| | - Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Kee-Hsin Chen
- Center for Nursing and Healthcare Research in Clinical Practice Application, Taipei Municipal Wanfang Hospital-Taipei Medical University, Taipei, Taiwan.,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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28
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Schieveld JNM, Strik JJMH. A Note on Common Apathy versus Hypoactive Delirium in Critical Illness. Am J Respir Crit Care Med 2021; 203:921-923. [PMID: 33434454 DOI: 10.1164/rccm.202011-4108le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Jan N M Schieveld
- Maastricht University Medical Center Maastricht, the Netherlands.,South Limburg Mental Health Research and Teaching Network Maastricht, the Netherlands and.,Mutsaersstichting Venlo, the Netherlands
| | - Jacqueline J M H Strik
- Maastricht University Medical Center Maastricht, the Netherlands.,South Limburg Mental Health Research and Teaching Network Maastricht, the Netherlands and.,Mutsaersstichting Venlo, the Netherlands
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29
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Delirium and Associated Length of Stay and Costs in Critically Ill Patients. Crit Care Res Pract 2021; 2021:6612187. [PMID: 33981458 PMCID: PMC8088381 DOI: 10.1155/2021/6612187] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/27/2021] [Accepted: 04/15/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose Delirium frequently affects critically ill patients in the intensive care unit (ICU). The purpose of this study is to evaluate the impact of delirium on ICU and hospital length of stay (LOS) and perform a cost analysis. Materials and Methods Prospective studies and randomized controlled trials of patients in the ICU with delirium published between January 1, 2015, and December 31, 2020, were evaluated. Outcome variables including ICU and hospital LOS were obtained, and ICU and hospital costs were derived from the respective LOS. Results Forty-one studies met inclusion criteria. The mean difference of ICU LOS between patients with and without delirium was significant at 4.77 days (p < 0.001); for hospital LOS, this was significant at 6.67 days (p < 0.001). Cost data were extractable for 27 studies in which both ICU and hospital LOS were available. The mean difference of ICU costs between patients with and without delirium was significant at $3,921 (p < 0.001); for hospital costs, the mean difference was $5,936 (p < 0.001). Conclusion ICU and hospital LOS and associated costs were significantly higher for patients with delirium, compared to those without delirium. Further research is necessary to elucidate other determinants of increased costs and cost-reducing strategies for critically ill patients with delirium. This can provide insight into the required resources for the prevention of delirium, which may contribute to decreasing healthcare expenditure while optimizing the quality of care.
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30
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Li Y, Zhao L, Yang C, Yu Z, Song J, Zhou Q, Zhang X, Gao J, Wang Q, Wang H. Development and Validation of a Clinical Prediction Model for Sleep Disorders in the ICU: A Retrospective Cohort Study. Front Neurosci 2021; 15:644845. [PMID: 33935633 PMCID: PMC8085546 DOI: 10.3389/fnins.2021.644845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/29/2021] [Indexed: 12/13/2022] Open
Abstract
Background Sleep disorders, the serious challenges faced by the intensive care unit (ICU) patients are important issues that need urgent attention. Despite some efforts to reduce sleep disorders with common risk-factor controlling, unidentified risk factors remain. Objectives This study aimed to develop and validate a risk prediction model for sleep disorders in ICU adults. Methods Data were retrieved from the MIMIC-III database. Matching analysis was used to match the patients with and without sleep disorders. A nomogram was developed based on the logistic regression, which was used to identify risk factors for sleep disorders. The calibration and discrimination of the nomogram were evaluated with the 1000 bootstrap resampling and receiver operating characteristic curve (ROC). Besides, the decision curve analysis (DCA) was applied to evaluate the clinical utility of the prediction model. Results 2,082 patients were included in the analysis, 80% of whom (n = 1,666) and the remaining 20% (n = 416) were divided into the training and validation sets. After the multivariate analysis, hemoglobin, diastolic blood pressure, respiratory rate, cardiovascular disease, and delirium were the independent risk predictors for sleep disorders. The nomogram showed high sensitivity and specificity of 75.6% and 72.9% in the ROC. The threshold probability of the net benefit was between 55% and 90% in the DCA. Conclusion The model showed high performance in predicting sleep disorders in ICU adults, the good clinical utility of which may be a useful tool for providing clinical decision support to improve sleep quality in the ICU.
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Affiliation(s)
- Yun Li
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, China
| | - Lina Zhao
- Emergency Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chenyi Yang
- Department of Anesthesiology, The Third Central Hospital of Tianjin, The Third Central Clinical College of Tianjin Medical University, Nankai University Affinity the Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Zhiqiang Yu
- Department of Anesthesiology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, China
| | - Jiannan Song
- Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, China
| | - Qi Zhou
- Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, China
| | - Xizhe Zhang
- Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, China
| | - Jie Gao
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Qiang Wang
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Haiyun Wang
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China.,Department of Anesthesiology, The Third Central Hospital of Tianjin, The Third Central Clinical College of Tianjin Medical University, Nankai University Affinity the Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
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Abstract
Traumatic injury remains the leading cause of death among individuals younger than age 45 years. Hemorrhage is the primary preventable cause of death in trauma patients. Management of hemorrhage focuses on rapidly controlling bleeding and addressing the lethal triad of hypothermia, acidosis, and coagulopathy. The principles of damage control surgery are rapid control of hemorrhage, temporary control of contamination, resuscitation in the intensive care unit to restore normal physiology, and a planned, delayed definitive operative procedure. Damage control resuscitation focuses on 3 key components: fluid restriction, permissive hypotension, and fixed-ratio transfusion. Rapid recognition and control of hemorrhage and implementation of resuscitation strategies to control damage have significantly improved mortality and morbidity rates. In addition to describing the basic principles of damage control surgery and damage control resuscitation, this article explains specific management considerations for and potential complications in patients undergoing damage control interventions in an intensive care unit.
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Affiliation(s)
- Shannon Gaasch
- Shannon Gaasch is Senior Nurse Practitioner II, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201 (Shannon. )
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32
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Nakamizo T, Kanda T, Kudo Y, Sugawara E, Hashimoto E, Okazaki A, Usuda M, Nagai T, Hara H, Johkura K. Effects of uncomfortable care and histamine H2-antagonists on delirium in acute stroke: A propensity score analysis. J Neurol Sci 2020; 420:117251. [PMID: 33276246 DOI: 10.1016/j.jns.2020.117251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/28/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Uncomfortable care and histamine H2 antagonist (H2A) are implicated in precipitating delirium. In acute stroke, however, the need for them depends on stroke severity, an established risk factor for delirium. So, it is unclear whether care or H2A itself is responsible for delirium. We aimed to evaluate their causal effects on delirium in acute stroke patients. METHODS This is a prospective cohort study on acute stroke patients admitted to a stroke care unit. Patients without stupor, coma, sedation, or delirium upon admission were enrolled. The treatment was H2A and five care modalities given during the first 24 h: restraint use, prohibited self-transfer, no oral feeding, indwelling catheters, and frequent nighttime care. The outcome was delirium within 5 days defined as Intensive Care Delirium Screening Checklist ≥4 points. We estimated the relative risk (RR) for delirium with regression models weighted by overlap weights using propensity scores estimated through logistic models incorporating known and potential confounders, including stroke severity. RESULTS Of the 387 participants, 188 were given at least one care modality and 130 were given H2A. A total of 42 developed delirium. Delirium was significantly associated with prohibited self-transfer (RR 1.7, 95% CI 1.0-3.0), frequent nighttime care (RR 2.1, 95% CI 1.2-3.7), and multiple care modalities (RR 2.4, 95% CI 1.3-4.4), while other care modalities and H2A were not. CONCLUSIONS This study showed possible causal effects of uncomfortable care on delirium and suggests that minimizing it could prevent delirium in acute stroke.
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Affiliation(s)
- Tomoki Nakamizo
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan; Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan
| | - Toshie Kanda
- Department of Nursing, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Yosuke Kudo
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Eriko Sugawara
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Erina Hashimoto
- Department of Nursing, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Ayana Okazaki
- Department of Nursing, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Makoto Usuda
- Department of Pharmacy, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Toru Nagai
- Department of Pharmacy, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Hiroshi Hara
- Department of Pharmacy, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Ken Johkura
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan.
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Battaglini D, Santori G, Chandraptham K, Iannuzzi F, Bastianello M, Tarantino F, Ball L, Giacobbe DR, Vena A, Bassetti M, Inglese M, Uccelli A, Rocco PRM, Patroniti N, Brunetti I, Pelosi P, Robba C. Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically Ill Mechanically Ventilated COVID-19 Patients. Front Neurol 2020; 11:602114. [PMID: 33329361 PMCID: PMC7729072 DOI: 10.3389/fneur.2020.602114] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/19/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose: The incidence and the clinical presentation of neurological manifestations of coronavirus disease-2019 (COVID-19) remain unclear. No data regarding the use of neuromonitoring tools in this group of patients are available. Methods: This is a retrospective study of prospectively collected data. The primary aim was to assess the incidence and the type of neurological complications in critically ill COVID-19 patients and their effect on survival as well as on hospital and intensive care unit (ICU) length of stay. The secondary aim was to describe cerebral hemodynamic changes detected by noninvasive neuromonitoring modalities such as transcranial Doppler, optic nerve sheath diameter (ONSD), and automated pupillometry. Results: Ninety-four patients with COVID-19 admitted to an ICU from February 28 to June 30, 2020, were included in this study. Fifty-three patients underwent noninvasive neuromonitoring. Neurological complications were detected in 50% of patients, with delirium as the most common manifestation. Patients with neurological complications, compared to those without, had longer hospital (36.8 ± 25.1 vs. 19.4 ± 16.9 days, p < 0.001) and ICU (31.5 ± 22.6 vs. 11.5±10.1 days, p < 0.001) stay. The duration of mechanical ventilation was independently associated with the risk of developing neurological complications (odds ratio 1.100, 95% CI 1.046-1.175, p = 0.001). Patients with increased intracranial pressure measured by ONSD (19% of the overall population) had longer ICU stay. Conclusions: Neurological complications are common in critically ill patients with COVID-19 receiving invasive mechanical ventilation and are associated with prolonged ICU length of stay. Multimodal noninvasive neuromonitoring systems are useful tools for the early detection of variations in cerebrovascular parameters in COVID-19.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Karthikka Chandraptham
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Francesca Iannuzzi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Matilde Bastianello
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Fabio Tarantino
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Infectious Diseases, San Martino Policlinico Hospital - Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
| | - Antonio Vena
- Department of Infectious Diseases, San Martino Policlinico Hospital - Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Bassetti
- Department of Infectious Diseases, San Martino Policlinico Hospital - Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Antonio Uccelli
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Rio de Janeiro Network on Neuroinflammation, Carlos Chagas Filho Foundation for Supporting Research in the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
- COVID-19 Virus Network, Ministry of Science and Technology, and Innovation, Rio de Janeiro, Brazil
| | - Nicolò Patroniti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Iole Brunetti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
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Abstract
Delirium is an acute confusional state that is common and costly and is associated with significant functional decline and distress. It is the manifestation of acute encephalopathy and is variably called acute brain failure, acute brain dysfunction, or altered mental status. All patients are at risk for delirium, although those with more vulnerabilities (such as advanced age, exposures to other stressors like infection, and certain medications) are at higher risk. The pathophysiologic cause of delirium is not well understood. It is important to recognize patients at risk for and those with delirium and to immediately identify and treat factors contributing to it. There is no single intervention or medication to treat delirium, making it challenging to manage. Therefore, risk mitigation and prompt treatment rely on a sophisticated strategy to address the contributing factors. Delirium may be prevented or attenuated when multimodal strategies are used, thereby improving patient outcomes.
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Affiliation(s)
- Melissa L P Mattison
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (M.L.M.)
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Zhai Y, Cai S, Zhang Y. The Diagnostic Accuracy of Critical Care Pain Observation Tool (CPOT) in ICU Patients: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2020; 60:847-856.e13. [PMID: 32544649 DOI: 10.1016/j.jpainsymman.2020.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The critical care pain observation tool (CPOT) has been widely used to assess pain in ICU patients, and its validity and reliability have been tested in various contexts. OBJECTIVE To determine the diagnostic accuracy of the CPOT in critically ill patients, a systematic review of diagnostic studies was performed. METHODS A database search (PubMed, Medline, CINAHL, ProQuest, EMBASE, Cochrane Library, CNKI, Wanfang, COVIP, CBM) was conducted, as was the manual identification of eligible papers from citations. Eligible studies were published between 2006 and February 2020. Quality appraisal of the studies was carried out with the QUADAS-2 checklist, and data extraction was performed in alignment with STARD 2015. Open Meta Analyst was used for the statistical analysis. RESULTS In total, 25 articles involving 1920 subjects with 3493 experimental results were included. Most of the studies were of fair quality. A high degree of heterogeneity (I2 = 57.2%, P < 0.001) was discovered. The Youden index values were 1.56 and 1.55 when the CPOT threshold was set at two and three, respectively. The diagnostic performance of the CPOT was affected by the reference standard. The CPOT had a higher diagnostic odds ratio of 11.52 (95% CI: 7.42-17.87) during nociceptive procedures compared with 9.14 (95% CI: 5.38-15.53) at rest or during non-nociceptive procedures. CONCLUSION CPOT has moderate diagnostic parameters with a threshold of two or three, suggesting that it is a fair but not excellent tool. More research on the validity of the CPOT in specific subgroups is needed to broaden its applicability in critical care.
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Affiliation(s)
- Yue Zhai
- School of Nursing, Fudan University, Shanghai, China
| | - Shining Cai
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuxia Zhang
- School of Nursing, Fudan University, Shanghai, China; Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China.
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36
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Abstract
Purpose of review Sleep is intimately involved in overall health and wellbeing. We provide a comprehensive report on the interplay between systemic diseases and sleep to optimize the outcomes of systemic disorders. Recent findings Spanning the categories of endocrinologic disorders, metabolic/toxic disturbances, renal, cardiovascular, pulmonary, gastrointestinal, infectious diseases, autoimmune disorders, malignancy, and critical illness, the review highlights the prevalent coexisting pathology of sleep across the spectrum of systemic disorders. Although it is rare that treating a sleep symptom can cure disease, attention to sleep may improve quality of life and may mitigate or improve the underlying disorder. Recent controversies in assessing the cardiovascular relationship with sleep have called into question some of the benefits of treating comorbid sleep disorders, thereby highlighting the need for an ongoing rigorous investigation into how sleep interplays with systemic diseases. Summary Systemic diseases often have sleep manifestations and this report will help the clinician identify key risk factors linking sleep disorders to systemic diseases so as to optimize the overall care of the patient.
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Affiliation(s)
- Eric M. Davis
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA USA
| | - Chintan Ramani
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA USA
| | - Mark Quigg
- Department of Neurology, University of Virginia, Charlottesville, VA USA
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INCIDENCIA DE DELIRIO SEGÚN EL REGIMEN DE VISITAS EN UNA UNIDAD DE CUIDADOS INTENSIVOS. ENFERMERIA INTENSIVA 2020. [DOI: 10.1016/j.enfi.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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38
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Kim DJ, Sohn B, Kim H, Chang HW, Lee JH, Kim JS, Lim C, Park KH. The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:8-15. [PMID: 32090052 PMCID: PMC7006613 DOI: 10.5090/kjtcs.2020.53.1.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 12/03/2022]
Abstract
Background We aimed to investigate the associations of critical care provided in a cardiac surgical intensive care unit (CSICU) staffed by an attending intensivist with improvements in intensive care unit (ICU) quality and reductions in postoperative complications. Methods Patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2007 and December 2012 (the control group) were propensity-matched (1:1) to CABG patients between January 2013 and June 2018 (the intensivist group). Results Using propensity score matching, 302 patients were extracted from each group. The proportion of patients with at least 1 postoperative complication was significantly lower in the intensivist group than in the control group (17.2% vs. 28.5%, p=0.001). In the intensivist group, the duration of mechanical ventilation (6.4±13.7 hours vs. 13.7±49.3 hours, p=0.013) and length of ICU stay (28.7±33.9 hours vs. 41.7±90.4 hours, p=0.018) were significantly shorter than in the control group. The proportions of patients with prolonged mechanical ventilation (2.3% vs. 7.6%, p=0.006), delirium (1.3% vs. 6.3%, p=0.003) and acute kidney injury (1.3% vs. 5.3%, p=0.012) were significantly lower in the intensivist group than in the control group. Conclusion A transition from an open ICU model with trainee coverage to a closed ICU model with attending intensivist coverage can be expected to yield improvements in CSICU quality and reductions in postoperative complications.
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Affiliation(s)
- Dong Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bongyeon Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hakju Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyoung Woo Chang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Hang Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jun Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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