Delirium assessment using Confusion Assessment Method for the Intensive Care Unit in Chinese critically ill patients

Background Delirium is a complex syndrome prevalent in the intensive care unit. It has been associated with significant morbidity including distress, longer hospital stays, prolonged cognitive impairment, and increased mortality. Objective To describe a nurse-led interdisciplinary quality improvement initiative to increase nurses’ knowledge of delirium, documentation of delirium assessment, and patient mobility. Methods Sixty-seven nurses in medical and surgical intensive care units were required to attend an interactive education program on delirium assessment and management. Scores on tests taken before and after the education program were used to evaluate knowledge. Medical records and bedside rounds were used to validate Confusion Assessment Method for the Intensive Care Unit documentation and interventions. Descriptive statistics were used to describe changes over time. A delirium resource team composed of nurses, physicians, and therapists provided didactic education paired with simulation training and bedside coaching. Mobility screening tests and computer templates guided assessments and interventions. Results Documentation of the Confusion Assessment Method improved from less than 50% to consistently 99%. Mobilization in the surgical intensive care unit increased from 90% to 98% after intervention. Days of delirium significantly decreased from 51% before intervention to 31% after intervention (χ12=7.01, P = .008). Conclusions The success of this quality improvement project to enhance recognition of delirium and increase mobility (critical components of the pain assessment, breathing, sedation choice, delirium, early mobility, and family education bundle) was contingent on nursing leaders hip, interdisciplinary team collaboration, and interactive education.

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Investigation of Delirium in Critically Ill Children:Japanese Version of the Pediatric Confusion Assessment Method for the Intensive Care Unit（ pCAM-ICU）

Journal of Japan Academy of Critical Care Nursing ◽

10.11153/jaccn.7.1_45 ◽

2011 ◽

Vol 7 (1) ◽

pp. 45-51 ◽

Cited By ~ 1

Author(s):

Ryosuke Tsuruta ◽

Hiroaki Yamase

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Confusion Assessment Method ◽

Assessment Method ◽

Confusion Assessment

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Delirium in Critically Ill Patients

10.1093/med/9780199398690.003.0002 ◽

2017 ◽

Author(s):

Mark van den Boogaard ◽

Paul Rood

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Hearing Aids ◽

Critically Ill Patients ◽

Early Mobilization ◽

Confusion Assessment Method ◽

Assessment Method ◽

Assessment Tools ◽

Delirium Assessment ◽

Nighttime Sleep

This chapter addresses delirium in critically ill patients in the intensive care unit (ICU), especially the mixed subtype (alternating hyperactivity and hypoactivity). The Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist are discussed as useful delirium assessment tools in this setting. Several neurotransmitter pathways have been implicated in delirium, including cholinergic, GABAergic, and serotonergic pathways; cytokines and glucocorticoids also appear relevant. Risk factors for delirium in the ICU include older age, prior cognitive impairment, worse illness severity, recent delirium or coma, mechanical ventilation, admission category (especially trauma or neurological/neurosurgical admission), infection, metabolic acidosis, morphine and sedative administration, urea concentration, respiratory failure, and admission urgency. Prevention and treatment of delirium are discussed, including nonpharmacological interventions (frequent reorientation, providing eyeglasses and hearing aids if needed, promoting nighttime sleep, and early mobilization) and judicious use of opiate, sedative, and antipsychotic medications.

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Serum melatonin concentration in critically ill patients randomized to sedation or non-sedation

Annals of Intensive Care ◽

10.1186/s13613-021-00829-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jakob Oxlund ◽

Torben Knudsen ◽

Thomas Strøm ◽

Jørgen T. Lauridsen ◽

Poul J. Jennum ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Confusion Assessment Method ◽

Assessment Method ◽

Secondary Outcome ◽

Melatonin Level ◽

Melatonin Concentration ◽

Mechanically Ventilated

Abstract Background Abolished circadian rhythm is associated with altered cognitive function, delirium, and as a result increased mortality in critically ill patients, especially in those who are mechanically ventilated. The causes are multifactorial, of which changes in circadian rhythmicity may play a role. Melatonin plays a crucial role as part of the circadian and sleep/wake cycle. Whether sedation effects circadian regulation is unknown. Hence, the objective of this study was to evaluate the melatonin concentration in critically ill patients randomized to sedation or non-sedation and to investigate the correlation with delirium. Methods All patients were included and randomized at the intensive care unit at the hospital of southwest Jutland, Denmark. Seventy-nine patients completed the study (41 sedated and 38 non-sedated). S-melatonin was measured 3 times per day, (03.00, 14.00, and 22.00), for 4 consecutive days in total, starting on the second day upon randomization/intubation. The study was conducted as a sub-study to the NON-SEDA study in which one hundred consecutive patients were randomized to sedation or non-sedation with a daily wake-up call (50 in each arm). Primary outcome: melatonin concentration in sedated vs. non-sedated patients (analyzed using linear regression). Secondary outcome: risk of developing delirium or non-medically induced (NMI) coma in sedated vs. non-sedated patients, assessed by CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) analyzed using logistic regression. Results Melatonin concentration was suppressed in sedated patients compared to the non-sedated. All patients experienced an elevated peak melatonin level early on in the course of their critical illness (p = 0.01). The risk of delirium or coma (NMI) was significantly lower in the non-sedated group (OR 0.42 CI 0.27; 0.66 p < 0.0001). No significant relationship between delirium development and suppressed melatonin concentration was established in this study (OR 1.004 p = 0.29 95% CI 0.997; 1.010). Conclusion Melatonin concentration was suppressed in sedated, critically ill patients, when compared to non-sedated controls and the frequency of delirium was elevated in sedated patients. Trail registration Clinicaltrials.gov (NCT01967680) on October 23, 2013.

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