Encephalopathy and Delirium

10.2310/anes.8221 ◽

2019 ◽

Author(s):

Alliya S. Qazi ◽

Juliana Barr

Keyword(s):

Risk Factors ◽

Clinical Judgment ◽

Assessment Tool ◽

Severity Of Illness ◽

Pharmacologic Agent ◽

Detection Rates ◽

Benzodiazepine Use ◽

Icu Delirium ◽

Abcdef Bundle

Delirium occurs commonly in critically ill patients. ICU delirium is associated with increased short-term and long-term mortality, increased ICU length of stay, and long-term cognitive deficits in these patients. There are significant health-care costs associated with ICU delirium. Delirium is often overlooked in patients when assessed by clinicians based on clinical judgment alone. The use of a validated delirium assessment tool increases delirium detection rates in patients. ICU delirium is a multifactorial process. Nonmodifiable risk factors include age, dementia, prior coma, emergency surgery or trauma, and a high severity of illness. Modifiable risk factors include benzodiazepine use and blood transfusions. There is no evidence to support the use of any pharmacologic agent for either the prevention or treatment of ICU delirium. Antipsychotics should only be used for symptom management in ICU patients with delirium, and then discontinued when no longer needed. The mainstay of delirium management should be a multi-component, non-pharmacologic strategy aimed at minimizing risk factors. One such multimodal strategy, the ABCDEF Bundle, can significantly decrease the incidence of ICU delirium. Additional research is needed to better understand the pathophysiology and management of ICU delirium. This review contains 5 figures, 5 tables, and 50 references. Keywords: Delirium, Encephalopathy, Intensive Care, Outcomes, ABCDEF Bundle, ICU Liberation.

Download Full-text

Encephalopathy and Delirium

10.2310/psych.8221 ◽

2019 ◽

Author(s):

Alliya S. Qazi ◽

Juliana Barr

Keyword(s):

Risk Factors ◽

Clinical Judgment ◽

Assessment Tool ◽

Severity Of Illness ◽

Pharmacologic Agent ◽

Detection Rates ◽

Benzodiazepine Use ◽

Icu Delirium ◽

Abcdef Bundle

Delirium occurs commonly in critically ill patients. ICU delirium is associated with increased short-term and long-term mortality, increased ICU length of stay, and long-term cognitive deficits in these patients. There are significant health-care costs associated with ICU delirium. Delirium is often overlooked in patients when assessed by clinicians based on clinical judgment alone. The use of a validated delirium assessment tool increases delirium detection rates in patients. ICU delirium is a multifactorial process. Nonmodifiable risk factors include age, dementia, prior coma, emergency surgery or trauma, and a high severity of illness. Modifiable risk factors include benzodiazepine use and blood transfusions. There is no evidence to support the use of any pharmacologic agent for either the prevention or treatment of ICU delirium. Antipsychotics should only be used for symptom management in ICU patients with delirium, and then discontinued when no longer needed. The mainstay of delirium management should be a multi-component, non-pharmacologic strategy aimed at minimizing risk factors. One such multimodal strategy, the ABCDEF Bundle, can significantly decrease the incidence of ICU delirium. Additional research is needed to better understand the pathophysiology and management of ICU delirium. This review contains 5 figures, 5 tables, and 50 references. Keywords: Delirium, Encephalopathy, Intensive Care, Outcomes, ABCDEF Bundle, ICU Liberation.

Download Full-text

Encephalopathy and Delirium

10.2310/7ccsp.8221 ◽

2019 ◽

Author(s):

Alliya S. Qazi ◽

Juliana Barr

Keyword(s):

Risk Factors ◽

Clinical Judgment ◽

Assessment Tool ◽

Severity Of Illness ◽

Pharmacologic Agent ◽

Detection Rates ◽

Benzodiazepine Use ◽

Icu Delirium ◽

Abcdef Bundle

Delirium occurs commonly in critically ill patients. ICU delirium is associated with increased short-term and long-term mortality, increased ICU length of stay, and long-term cognitive deficits in these patients. There are significant health-care costs associated with ICU delirium. Delirium is often overlooked in patients when assessed by clinicians based on clinical judgment alone. The use of a validated delirium assessment tool increases delirium detection rates in patients. ICU delirium is a multifactorial process. Nonmodifiable risk factors include age, dementia, prior coma, emergency surgery or trauma, and a high severity of illness. Modifiable risk factors include benzodiazepine use and blood transfusions. There is no evidence to support the use of any pharmacologic agent for either the prevention or treatment of ICU delirium. Antipsychotics should only be used for symptom management in ICU patients with delirium, and then discontinued when no longer needed. The mainstay of delirium management should be a multi-component, non-pharmacologic strategy aimed at minimizing risk factors. One such multimodal strategy, the ABCDEF Bundle, can significantly decrease the incidence of ICU delirium. Additional research is needed to better understand the pathophysiology and management of ICU delirium. This review contains 5 figures, 5 tables, and 50 references. Keywords: Delirium, Encephalopathy, Intensive Care, Outcomes, ABCDEF Bundle, ICU Liberation.

Download Full-text

Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211015582 ◽

2021 ◽

pp. 000348942110155

Author(s):

Leonard Haller ◽

Khush Mehul Kharidia ◽

Caitlin Bertelsen ◽

Jeffrey Wang ◽

Karla O’Dell

Keyword(s):

Risk Factors ◽

Medical Records ◽

Assessment Tool ◽

Demographic Data ◽

Anterior Cervical Discectomy ◽

Cervical Discectomy ◽

Long Term Follow Up

Objective: We sought to identify risk factors associated with long-term dysphagia, characterize changes in dysphagia over time, and evaluate the incidence of otolaryngology referrals for patients with long-term dysphagia following anterior cervical discectomy with fusion (ACDF). Methods: About 56 patients who underwent ACDF between May 2017 to February 2019 were included in the study. All patients were assessed for dysphagia using the Eating Assessment Tool (EAT-10) survey preoperatively and late postoperatively (≥1 year). Additionally, 28 patients were assessed for dysphagia early postoperatively (2 weeks—3 months). Demographic data, medical comorbidities, intraoperative details, and post-operative otolaryngology referral rates were collected from electronic medical records. Results: Of the 56 patients enrolled, 21 patients (38%) had EAT-10 scores of 3 or more at long-term follow-up. None of the demographics, comorbidities, or surgical factors assessed were associated with long-term dysphagia. Patients who reported no long-term dysphagia had a mean EAT-10 score of 6.9 early postoperatively, while patients with long-term symptoms had a mean score of 18.1 ( P = .006). Of the 21 patients who reported persistent dysphagia symptoms, 3 (14%) received dysphagia testing or otolaryngology referrals post-operatively. Conclusion: Dysphagia is a notable side effect of ACDF surgery, but there are no significant demographics, comorbidities, or surgical risk factors that predict long-term dysphagia. Early postoperative characterization of dysphagia using the EAT-10 questionnaire can help predict long-term symptoms. There is inadequate screening and otolaryngology follow-up for patients with post-ACDF dysphagia.

Download Full-text

New Persistent Opioid and Benzodiazepine Use After Curative-Intent Treatment in Patients With Breast Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7612 ◽

2021 ◽

Vol 19 (1) ◽

pp. 29-38 ◽

Cited By ~ 1

Author(s):

Mandy R. Sakamoto ◽

Megan Eguchi ◽

Christine M. Azelby ◽

Jennifer R. Diamond ◽

Christine M. Fisher ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Population Based ◽

Opioid Use ◽

Curative Intent ◽

Patients With Cancer ◽

Healthcare Crisis ◽

Benzodiazepine Use ◽

Use Factors

Background: Opioid and benzodiazepine use and abuse is a national healthcare crisis to which patients with cancer are particularly vulnerable. Long-term use and risk factors for opioid and benzodiazepine use in patients with breast cancer is poorly characterized. Methods: We conducted a retrospective population-based study of patients with breast cancer diagnosed between 2008 and 2015 undergoing curative-intent treatment identified through the SEER-Medicare linked database. Primary outcomes were new persistent opioid use and new persistent benzodiazepine use. Factors associated with new opioid and benzodiazepine use were investigated by univariate and multivariable logistic regression. Results: Among opioid-naïve patients, new opioid use was observed in 22,418 (67.4%). Of this group, 611 (2.7%) developed persistent opioid use at 3 months and 157 (0.7%) at 6 months after treatment. Risk factors for persistent use at 3 and 6 months included stage III disease (odds ratio [OR], 2.16; 95% CI, 1.49–3.12, and OR, 3.48; 95% CI, 1.58–7.67), surgery plus chemotherapy (OR, 1.44; 95% CI, 1.10–1.88, and OR, 2.28; 95% CI, 1.40–3.71), surgery plus chemoradiation therapy (OR, 1.47; 95% CI, 1.10–1.96, and OR, 2.34; 95% CI, 1.38–3.96), and initial tramadol use (OR, 2.66; 95% CI, 2.05–3.46, and OR, 3.12; 95% CI, 1.93–5.04). Among benzodiazepine-naïve patients, new benzodiazepine use was observed in 955 (10.3%), and 111 (11.6%) developed new persistent use at 3 months. Tamoxifen use was statistically significantly associated with new persistent benzodiazepine use at 3 months. Conclusions: A large percentage of patients receiving curative-intent treatment of breast cancer were prescribed new opioids; however, only a small number developed new persistent opioid use. In contrast, a smaller proportion of patients received a new benzodiazepine prescription; however, new persistent use after completion of treatment was more likely and particularly related to concurrent treatment with tamoxifen.

Download Full-text

Facteurs associés à la consommation de courte et de longue durée des benzodiazépines chez les personnes âgées du Québec

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1353/cja.2005.0062 ◽

2005 ◽

Vol 24 (2) ◽

pp. 103-113 ◽

Cited By ~ 4

Author(s):

Dany Fortin ◽

Michel Préville ◽

Claire Ducharme ◽

Réjean Hébert ◽

Jacques Allard ◽

...

Keyword(s):

Risk Factors ◽

Multinomial Logistic Regression ◽

Female Gender ◽

The Elderly ◽

Elderly Persons ◽

Factors Associated ◽

Benzodiazepine Use ◽

Short And Long Term ◽

Chronic Health Problems

ABSTRACTIn Quebec, benzodiazepines are some of the most extensively used drugs by the elderly. The goal of this study was to identify factors associated with short- and long-term benzodiazepine use among 2,039 elderly persons having participated in the Quebec Health Survey conducted in 1998. Results of the multivariate, multinomial logistic regression showed that a higher number of chronic health problems, a higher number of physicians visited and general practitioners consulted were associated with short- and long-term use of benzodiazepines. Factors specifically associated with long-term use were female gender (OR=1.84) and the presence of benzodiazepine users in the household (OR=1.90). In this study, we were unable to show a difference between the two groups of users with regards to the risk factors studied. This result leads us to conclude that prevention of long-term use must be aimed at all new benzodiazepine users.

Download Full-text