scholarly journals E.04 Coma and delirium are associated with low levels of brain tissue oxygen in critically ill patients

2016 ◽  
Vol 43 (S2) ◽  
pp. S17-S17
Author(s):  
MD Wood ◽  
D Maslove ◽  
J Muscedere ◽  
JG Boyd
Keyword(s):  
Brain Tissue ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Near Infrared ◽  
Neurological Status ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Brain Tissue Oxygenation ◽  
Low Levels ◽  
Icu Delirium

Background: The cause of ICU delirium is unknown. We used near infrared spectroscopy (NIRS) to measure brain tissue oxygenation (BtO2) in critically ill patients, to test the hypothesis that poor cerebral oxygen delivery contributes to ICU delirium. Methods: Adult patients were enrolled if they required mechanical ventilation for >24 hours, and/or vasoactive agents. Patients were excluded if they had previous cognitive dysfunction, brain injury on admission, or a life expectancy <24 hours. BtO2 was measured for the first 24 hours of ICU admission. The confusion assessment method-ICU (CAM-ICU) was used to screen for delirium. Participants were designated to one of three groups on the basis of their predominant neurological status (comatose, delirious, or intact). Results: To date, 47 patients have been recruited. Both delirious and comatose patients’ had significantly lower BtO2 levels compared to intact patients (P<0.001). There was a significant correlation between hemoglobin and BtO2 (R2=0.347, P<0.01). However, when correlation analysis was conducted separately amongst the three groups, the delirious patients (R2=0.485, P<0.05) were the strongest contributors to this positive correlation. Conclusions: Delirious patients exhibited the lowest BtO2 recordings and demonstrated a significant association between Hb and BtO2. This study offers potential insight into the pathophysiology of ICU delirium.

scholarly journals Incidence and Risk Factors of Delirium in the Intensive Care Unit: A Prospective Cohort

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Farshid Rahimi-Bashar ◽  
Ghazal Abolhasani ◽  
Nahid Manouchehrian ◽  
Nasrin Jiryaee ◽  
Amir Vahedian-Azimi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Cox Model ◽  
Scoring Systems ◽  
Confusion Assessment Method ◽  
Assessment Method

Purpose. The purpose of this study was to determine the incidence, risk factors, and impact of delirium on outcomes in ICU patients. In addition, the scoring systems were measured consecutively to characterize how these scores changed with time in patients with and without delirium. Material and Methods. A prospective cohort study enrolling 400 consecutive patients admitted to the ICU between 2018 and 2019 due to trauma or surgery. Patients were followed up for the development of delirium over ICU days using the Confusion Assessment Method (CAM) for the ICU and Intensive Care Delirium Screening Checklist (ICDSC). Cox model logistic regression analysis was used to explore delirium risk factors. Results. Delirium occurred in 108 (27%) patients during their ICU stay, and the median onset of delirium was 4 (IQR 3–4) days after admission. According to multivariate cox regression, the expected hazard for delirium was 1.523 times higher in patients who used mechanical ventilator as compared to those who did not (HR: 1.523, 95% CI: 1.197-2.388, P < 0.001 ). Conclusion. Our findings suggest that an important opportunity for improving the care of critically ill patients may be the determination of modifiable risk factors for delirium in the ICU. In addition, the scoring systems (APACHE IV, SOFA, and RASS) are useful for the prediction of delirium in critically ill patients.

Biomarker Predictors of Delirium in Acutely Ill Patients: A Systematic Review

2019 ◽  
Vol 32 (3) ◽  
pp. 119-136 ◽  
Author(s):  
Monique Michels ◽  
Cleonice Michelon ◽  
Danusa Damásio ◽  
Angeles Meller Vitali ◽  
Cristiane Ritter ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Comprehensive Evaluation ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment ◽  
Language Restriction ◽  
Specific Subgroup

Delirium is a serious and common disorder that affects up to 80% of acutely ill patients, mainly the aged. In recent years, several studies pointed out possible biomarkers that could be used alone or in combination with other resources in the diagnosis and follow-up of critically ill patients who develop delirium. In this context, a systematic review was conducted to determine the predictive value of several biomarkers in acutely (critically and noncritically) ill adult patients with delirium. Studies that used the confusion assessment method (CAM) and CAM-intensive care unit as the diagnostic method were considered. The most recent search was performed in November 2017. There was no language restriction. Initially, 626 articles were screened and 39 were included in the study. A comprehensive evaluation of the abstracts resulted in the exclusion of 202 studies, leaving 39 articles as potentially relevant. Inflammatory markers, S100β and cortisol, could predict delirium occurrence in a specific subgroup population of critically ill patients.

scholarly journals A Tunisian version of the Confusion Assessment Method for the intensive care unit (CAM-ICU): translation and validation

2020 ◽  
Author(s):  
Imen Ben Saida ◽  
Saiid Kortli ◽  
Badii Amamou ◽  
Nawres Kacem ◽  
Mariem Ghardallou ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Validity And Reliability ◽  
Rater Reliability ◽  
Predictive Values ◽  
Dsm V ◽  
Poor Outcomes

Abstract Background. Delirium is common in critically ill patients and it is associated with poor outcomes. In Tunisia, however, it is still underdiagnosed as there is no validated screening tool. The aim of this study was to translate and to validate a Tunisian version of the CAM-ICU. Methods. For the validation and inter-rater reliability assessment of the Tunisian CAM-ICU, two trained intensivists independently evaluated delirium in the patients admitted to the ICU between October 2017 and June 2018. All the patients consecutively admitted to the ICU for more than 24 hours and having a Richmond Agitation-Sedation Scale greater than or equal to “-3” were assessed for delirium excluding those with stroke, dementia, psychosis or persistent coma. The results were compared with the reference evaluation carried out by a psychiatrist using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. The inter-rater reliability was calculated using the kappa (κ) statistic. The CAM-ICU concurrent validity was assessed using Cronbach’s α coefficient, sensitivity, specificity as well as positive and negative predictive values (PPV and NPV, respectively) for the two Tunisian CAM-ICU raters. Results. The study involved 137 patients [median (IQR) age: 60 [49-68] years, male sex (n=102), invasive mechanical ventilation (n=49)]. Using the DSM-V criteria evaluations, 46 patients were diagnosed with delirium. When applying the Tunisian version of the CAM-ICU, 38(27.7%) patients were diagnosed with delirium for the first rater and 45(32.6%) patients for the second one. The Tunisian CAM-ICU showed a very-high inter-rater reliability for both intensivists (κ = 0.844, p<0.001). Using the DSM-V rater as the reference standard, the sensitivity of the two intensivists’ evaluations was 80.4 vs. 95.7%. Specificity was 98.9% for both. The Cronbach’s α of the first and second raters’ evaluations using the Tunisian version of the CAM-ICU were 0.886 and 0.887, respectively. Conclusions. The Tunisian version of the CAM-ICU showed almost perfect validity and reliability in detecting delirium in critically ill patients. It could therefore be used in Tunisian ICUs or where Tunisian translators are available following appropriate training.

scholarly journals A Tunisian version of the Confusion Assessment Method for the intensive care unit (CAM-ICU): translation and validation

2020 ◽  
Author(s):  
Imen Ben Saida ◽  
Saiid Kortli ◽  
Badii Amamou ◽  
Nawres Kacem ◽  
Mariem Ghardallou ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Validity And Reliability ◽  
Rater Reliability ◽  
Predictive Values ◽  
Dsm V ◽  
Poor Outcomes

Abstract Background. Delirium is common in critically ill patients and it is associated with poor outcomes. In Tunisia, however, it is still underdiagnosed as there is no validated screening tool. The aim of this study was to translate and to validate a Tunisian version of the CAM-ICU. Methods. For the validation and inter-rater reliability assessment of the Tunisian CAM-ICU, two trained intensivists independently evaluated delirium in the patients admitted to the ICU between October 2017 and June 2018. All the patients consecutively admitted to the ICU for more than 24 hours and having a Richmond Agitation-Sedation Scale greater than or equal to “-3” were assessed for delirium excluding those with stroke, dementia, psychosis or persistent coma. The results were compared with the reference evaluation carried out by a psychiatrist using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. The inter-rater reliability was calculated using the kappa (κ) statistic. The CAM-ICU concurrent validity was assessed using Cronbach’s α coefficient, sensitivity, specificity as well as positive and negative predictive values (PPV and NPV, respectively) for the two Tunisian CAM-ICU raters. Results. The study involved 137 patients [median (IQR) age: 60 [49-68] years, male sex (n=102), invasive mechanical ventilation (n=49)]. Using the DSM-V criteria evaluations, 46 patients were diagnosed with delirium. When applying the Tunisian version of the CAM-ICU, 38(27.7%) patients were diagnosed with delirium for the first rater and 45(32.6%) patients for the second one. The Tunisian CAM-ICU showed a very-high inter-rater reliability for both intensivists (κ = 0.844, p<0.001). Using the DSM-V rater as the reference standard, the sensitivity of the two intensivists’ evaluations was 80.4 vs. 95.7%. Specificity was 98.9% for both. The Cronbach’s α of the first and second raters’ evaluations using the Tunisian version of the CAM-ICU were 0.886 and 0.887, respectively. Conclusions. The Tunisian version of the CAM-ICU showed almost perfect validity and reliability in detecting delirium in critically ill patients. It could therefore be used in Tunisian ICUs or where Tunisian translators are available following appropriate training. Trial registration. Not applicable.

Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients

2017 ◽  
Vol 26 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Claudia DiSabatino Smith ◽  
Petra Grami
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Early Mobilization ◽  
Sensory Stimulation ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Surgical Intensive Care ◽  
Delirium Prevention

BackgroundStrategies for preventing delirium include early identification and avoiding or modifying patient, environmental, and iatrogenic factors. Minimal research exists on a prescriptive delirium prevention bundle that details elements or strategies for each bundle component. Even less research has been focused on nurse-driven interventions or components.ObjectiveTo evaluate the effectiveness of a delirium prevention bundle in decreasing delirium incidence in 2 medical-surgical intensive care units in a large Texas medical center.MethodsResearchers used the Confusion Assessment Method for the Intensive Care Unit to assess delirium incidence by using a controlled interventional cohort design with 447 delirium-negative critically ill patients. Bundle components consist of sedation cessation, pain management, sensory stimulation, early mobilization, and sleep promotion.ResultsThe intervention, analyzed by using a logistic regression model, reduced the odds of delirium by 78% (odds ratio, 0.22; P = .001).ConclusionsThe delirium prevention bundle was effective in reducing the incidence of delirium in critically ill medical-surgical patients. Further validation studies are under way.

Delirium in Critically Ill Patients

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.

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

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.

scholarly journals A Tunisian version of the Confusion Assessment Method for the intensive care unit (CAM-ICU): translation and validation

2019 ◽  
Author(s):  
Imen Ben Saida ◽  
Saiid Kortli ◽  
Badii Amamou ◽  
Nawres Kacem ◽  
Mariem Ghardallou ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Kappa Statistic ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Validity And Reliability ◽  
Rater Reliability ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Poor Outcomes

Abstract Background Delirium is common in critically ill patients and is associated with poor outcomes. In Tunisia, it remains however underdiagnosed, lacking a validated screening tool. The CAM-ICU is one of the most commonly used tools for detecting delirium in ICUs. The aim of the present study was to translate and validate a Tunisian version of the CAM-ICU. Methods A forward and backward translation was performed according to the guidelines suggested by the translation and cultural adaptation group. For the validation and inter-rater reliability assessment of the Tunisian CAM-ICU, two trained intensivists independently evaluated delirium in ICU patients admitted between October 2017 and June 2018. The results were compared with the reference evaluation carried out by a psychiatrist using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The inter-rater reliability was calculated using the kappa statistic. Results The related material of the Tunisian translated version of the CAM-ICU is currently available at the website www.icudelirium.org (last access: October 19, 2019). The study enrolled 137 patients. The Tunisian CAM-ICU showed a very high inter-rater reliability for both intensivists in terms of assessing delirium (Kappa=0.844, p<0.001). Using the DSM-5 rater as the reference standard, the sensitivity of the two intensivists’ evaluations were 80.4% vs. 95.7%. Specificity was 98.9% for both respectively. Conclusions The Tunisian version of the CAM-ICU showed excellent validity and reliability in detecting delirium in critically ill patients. It could therefore be used in Tunisian ICUs or where Tunisian translators are available following appropriate training. Trial registration: Not applicable.

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