scholarly journals Do we know if our Patients are Delirious?

2008 ◽  
Vol 9 (3) ◽  
pp. 269-269
Author(s):  
Callum Kaye

Delirium in the intensive care unit (ICU) setting is a significant cause of morbidity, mortality and increases ICU, as well as hospital length of stay1,2. Furthermore, with so many of the risk factors being present in the critically ill patient in the ICU environment, it's not surprising that other studies have found that up to 80% of patients will be delirious at some point during admission3,4. We performed a small study in a Toronto Medical-Surgical ICU using the Confusion Assessment Method for the ICU (CAM-ICU)5 to determine the prevalence of delirium in this unit. We concurrently reviewed medical and nursing notes to identify documentation of symptoms and signs that could indicate possible delirium during routine clinical assessment of the patient.

2007 ◽  
Vol 20 (5) ◽  
pp. 368-372 ◽  
Author(s):  
Brad Laible ◽  
Thomas Johnson

As appreciation grows for the negative impact delirium has on the clinical outcome of hospitalized patients, pharmacists are becoming more involved in the identification and treatment of this common problem. Delirium has been shown to have a significant impact on such factors as morbidity, mortality, and hospital length of stay. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) provides a simple assessment method for delirium that can be utilized by nonpsychiatrist personnel. While nonpharmacologic strategies are generally recommended to prevent and treat delirium, pharmacologic agents have also been investigated. This article will review causes of delirium, assessment with the CAM-ICU, and treatment options available to the pharmacist clinician.


Author(s):  
Andrea Kirfel ◽  
Jan Menzenbach ◽  
Vera Guttenthaler ◽  
Johanna Feggeler ◽  
Andreas Mayr ◽  
...  

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.


2021 ◽  
pp. 36-39
Author(s):  
Rohan Ainchwar ◽  
Harshawardhan Dhanraj Ramteke ◽  
Saniya Sheikh

Introduction: Many Patients admitted to Cardiac ICU (CICU) are easily prone to Delirium, that can lead to potentially severe consequences like Cognitive Impairment and increased risks of mortality. Delirium depends on the duration of hospital stay and discharge, contrary mainly affected to the patients on mechanical ventilation, which becomes the potential reason for longer duration. Studies suggest, Delirium is a widely discussed topic, when comes to the management of the patient in Cardiac ICU. During the Rounds, it is mandatory to focus on the diagnosis of delirium and must be validated using Confusion Assessment Method (CAM). These methods not only prevent the risk of the delirium and also enhances the use of the other preventive measures like the basis of the treatment, environmental factors, quiet time, sleep promotion, family support, communication with the patient, pain and dyspnea. When conrmed with delirium, pharmacological prophylaxis must be used as soon as possible. Most often, communication between Doctor, Nurse and Patient drives the most of the depression and acute delirium, but when delirium becomes critical with severe agitation or weaning from invasive mechanical ventilation. Thus, it is very important to identify the risk, complexity of the patients and clinical case scenarios of delirium in Cardiac ICU. Strategic Efforts were done to improve the identication of the patient at risk during admission, during stay at Cardiac ICU and during discharge and orders to improve the mental state of delirium patient. In this article, we provide a panorama of the incidence, risk factors, and impact on outcome of delirium in a Cardiac Intensive Care Unit (CICU). Methods: In this case study, total of 211 patients were observed for sign and symptoms in Cardiac ICU for Delirium. We aimed to determine the incidence, risk factors, and impact on outcome of delirium in a Cardiac Intensive Care Unit (CICU) in CHLMultispeciality Hospital and Research Center, Chandrapur using a prospective observational study. Patients:All consecutive patients admitted to the CICU between April 2021 and June 2021 were included if they were aged more than 18 years, had an CICU stay of more than 24 h and no psychiatric history. Patients eligible for the study were evaluated by the medical staff to detect delirium using the CAM. Results: In a 3-month period, 211 Patients were admitted in Cardiac ICU of CHLMultispeciality Hospital and Research Center. Out of which 198 were included in our observational study. The incidence of delirium at the end of the study was 21%. The number of delirious patients were 43 and non-delirious were 155. Age played an Important factor where 86% of Delirious patients were old aged. The LOS (Length of Stay) for Delirious and non-delirious patients were 6±1 vs 5±1 respectively. The SAS (Riker Agitation Scale) has the value of 4±1 vs 3±0.5, CAM (Confusion Assessment Method) has the value of 6±1 vs 3±1 and DDS (Delirium Detection Score) was 5±1 vs 3±1 for delirious vs non-delirious patients. The SAPS II (Simplied Acute Physiology Score II) Score for delirious patients was 23±1 and 20±2. The Incidences like Removal of Catheters were more frequent in this study with 20% in delirious patients and <1% Incidence in non-delirious patients. Removal of ET Tube had the Incidence of 5% vs <1%, Removal of Urinary Catheter 7% vs <1%, Removal of Ryle's Tube 7% vs <1%, respectively for delirious vs non-delirious patients.


2014 ◽  
Vol 23 (1) ◽  
pp. 60-69 ◽  
Author(s):  
Joshua T. Swan

Background The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a validated tool for diagnosing delirium in the ICU and yields 1 of 3 ratings: positive, negative, and unable to assess (UTA). It was hypothesized that an educational campaign focused on establishing patients’ arousal as comatose versus noncomatose before initiating the CAM-ICU would decrease the incidence of inappropriate UTA ratings. Objectives To compare the incidence of inappropriate UTA ratings before and after an educational campaign. Methods An interventional, quasi-experimental study was conducted in a surgical ICU at a tertiary academic medical center. A nursing educational campaign was conducted from March 1 to March 7, 2012. Patients admitted to the surgical ICU from December 25, 2011 through January 25, 2012 were included in the baseline cohort, and patients admitted from March 9 through April 9, 2012 were included in the posteducation cohort. Inclusion criteria were admission to the surgical ICU for at least 24 hours and at least 1 CAM-ICU assessment. Results The baseline cohort included 93 patients and the posteducation cohort included 96 patients. Patients were 41% less likely to receive an inappropriate UTA rating after the educational campaign (32% [30 of 93] baseline vs 19% [18 of 96], P = .03). Patients with concurrent mechanical ventilation were more likely to receive an inappropriate UTA rating in the baseline cohort (odds ratio, 30.7; 95% CI, 8.9–105.9; P &lt; .001) and the posteducation cohort (odds ratio, 15.5; 95% CI, 4.1–59.5; P &lt; .001). Conclusion The educational campaign decreased the incidence of inappropriate UTA ratings.


2021 ◽  
Vol 20 (3) ◽  
pp. 168-173
Author(s):  
FE Martinez ◽  
◽  
VW Ho ◽  
G Brogan ◽  
C Pickering ◽  
...  

Background: Delirium is common in intensive care and leads to increases in morbidity, mortality, Intensive Care Unit (ICU) length of stay, and hospital length of stay. Certain risk factors predict the appearance of delirium. Study Objectives: To determine the rates of delirium, the rate of risk factors, and their relationship to the occurrence of delirium in an adult ICU. Methods: Single-centre, prospective, observational study. Demographic and treatment data were collected. The Confusion Assessment Method for ICU (CAM-ICU) was performed twice daily to assess for delirium continuously during a 3-week period. Statistical analysis was used to determine the relationship between risk factors and the occurrence of delirium. Results: 86 patients were screened, 44 patients were included, and 260 patient-days were analyzed. The incidence of delirium was 42.9%, the prevalence of delirium in ICU was 50%. Urinary catheters and use of opioids were the most common factors with a positive association for occurrence of delirium. Exposure to daylight and sleeping for more than 4 hours at night were the factors most commonly associated with a lack of delirium. Conclusion: The rates of delirium in ICU were high and risk factors occurred frequently. Addressing modifiable risk factors, including the promotion of adequate sleep, could improve outcomes.


2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i31-i32
Author(s):  
D Semple ◽  
M M Howlett ◽  
J D Strawbridge ◽  
C V Breatnach ◽  
J C Hayden

Abstract Introduction Paediatric Delirium (PD) is a neuropsychiatric complication that occurs during the management of children in the critical care environment (Paediatric Intensive Care (PICU) and Neonatal Intensive Care (NICU). Delirium can be classified as hypoactive (decreased responsiveness and withdrawal), hyperactive (agitation and restlessness), and mixed (combined) (1). PD can be assessed using a number of assessment tools. PD has been historically underdiagnosed or misdiagnosed, having many overlapping symptoms with other syndrome such as pain and iatrogenic withdrawal syndrome (2). An appreciation of the extent of PD would help clinicians and policy makers drive interventions to improve recognition, prevention and management of PD in clinical practice. Aim To estimate the pooled prevalence of PD using validated assessment tools, and to identify risk factors including patient-related, critical-care related and pharmacological factors. Methods A systematic search of PubMed, EMBASE and CINAHL databases was undertaken. Eligible articles included observational studies or trials that estimated a prevalence of PD in a NICU/PICU population using a validated PD assessment tool. Validated tools are the paediatric Confusion Assessment Method-ICU (pCAM-ICU), the Cornell Assessment of Pediatric Delirium (CAPD), the PreSchool Confusion Assessment Method for the ICU (psCAM-ICU), pCAM-ICU severity scale (sspCAM-ICU), and the Sophia Observation Withdrawal Symptoms scale Paediatric Delirium scale (SOS-PD) (1). Only full text studies were included. No language restrictions were applied. Two reviewers independently screened records. Data was extracted using a pre-piloted form and independently verified by another reviewer. Quality was assessed using tools from the National Institutes of Health. A pooled prevalence was calculated from the studies that estimated PD prevalence using the most commonly applied tool, the CAPD (1). Results Data from 23 observational studies describing prevalence and risk factors for PD in critically ill children were included (Figure 1). Variability in study design and outcome reporting was found. Study quality was generally good. Using the validated tools prevalence ranged from 10–66% of patients. Hypoactive delirium was the most prevalent sub-class identified. Using the 13 studies that used the CAPD tool, a pooled prevalence of 35% (27%-43% 95%CI) was calculated. Younger ages, particularly less than two years old, sicker patients, particularly those undergoing mechanical and respiratory ventilatory support were more at risk for PD. Restraints, the number of sedative medications, including the cumulative use of benzodiazepines and opioids were identified as risk factors for the development of PD. PD was associated with longer durations of mechanical ventilation, longer stays and increased costs. Data on association with increased mortality risk is limited and conflicting. Conclusion PD affects one third of critical care admissions and is resource intense. Routine assessment in clinical practice may facilitate earlier detection and management strategies. Modifiable risk factors such as the class and number of sedative and analgesic medications used may contribute to the development of PD. Early mobility and lessening use of these medications present strategies to prevent PD occurrence. Longitudinal prospective multi-institutional studies to further investigate the presentations of the different delirium subtypes and modifiable risk factors that potentially contribute to the development of PD, are required. References 1. Semple D (2020) A systematic review and pooled prevalence of PD, including identification of the risk factors for the development of delirium in critically ill children. doi: 10.17605/OSF.IO/5KFZ8 2. Ista E, te Beest H, van Rosmalen J, de Hoog M, Tibboel D, van Beusekom B, et al. Sophia Observation withdrawal Symptoms-Paediatric Delirium scale: A tool for early screening of delirium in the PICU. Australian Critical Care. 2018;31(5):266–73


2001 ◽  
Author(s):  
E. Wesley Ely ◽  
Sharon K. Inouye ◽  
Gordon R. Bernard ◽  
Joseph Francis ◽  
Lisa May ◽  
...  

2019 ◽  
Vol 13 (3) ◽  
pp. 133-140 ◽  
Author(s):  
Ioannis Leotsakos ◽  
Ioannis Katafigiotis ◽  
Ofer N. Gofrit ◽  
Mordechai Duvdevani ◽  
Dionysios Mitropoulos

Purpose: We aimed to thoroughly search and identify studies referring to risk factors associated with postoperative delirium (POD) in patients undergoing open as well as en-doscopic urological surgery. Methods: The review after a systematic literature search included 5 studies. Results: The incidence of POD was reported to be between 7.8 and 30% depending on the type of the urologic surgery, while in the majority of the studies the onset happened on the first postoperative day and the symptoms lasted 3 ± 0.8 days. Seventeen different risk factors for POD were identified and presented in detail. Conclusion: The Mini-Mental State Examination score and older age were significantly associated with the development of POD. However, the Confusion Assessment Method is very well validated against the diagnosis of delirium from the specialists.


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