scholarly journals Advanced Age Is Associated With Catatonia in Critical Illness: Results From the Delirium and Catatonia Prospective Cohort Investigation

2021 ◽  
Vol 12 ◽  
Author(s):  
Jennifer Connell ◽  
Ahra Kim ◽  
Nathan E. Brummel ◽  
Mayur B. Patel ◽  
Simon N. Vandekar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Rating Scale ◽  
Medical Center ◽  
Adult Population ◽  
Academic Medical Center ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Advanced Age

Introduction: Catatonia, characterized by motor, behavioral and affective abnormalities, frequently co-occurs with delirium during critical illness. Advanced age is a known risk factor for development of delirium. However, the association between age and catatonia has not been described. We aim to describe the occurrence of catatonia, delirium, and coma by age group in a critically ill, adult population.Design: Convenience cohort, nested within two clinical trials and two observational cohort studies.Setting: Intensive care units in an academic medical center in Nashville, TN.Patients: 378 critically ill adult patients on mechanical ventilation and/or vasopressors.Measurements and Main Results: Patients were assessed for catatonia, delirium, and coma by independent and blinded personnel, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method for the Intensive Care Unit (ICU) and the Richmond Agitation and Sedation Scale. Of 378 patients, 23% met diagnostic criteria for catatonia, 66% experienced delirium, and 52% experienced coma during the period of observation. There was no relationship found between age and catatonia severity or age and presence of specific catatonia items. The prevalence of catatonia was strongly associated with age in the setting of critical illness (p < 0.05). Delirium and comas' association with age was limited to the setting of catatonia.Conclusion: Given the significant relationship between age and catatonia independent of coma and delirium status, these data demonstrate catatonia's association with advanced age in the setting of critical illness. Future studies can explore the causative factors for this association and further elucidate the risk factors for acute brain dysfunction across the age spectrum.

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.

scholarly journals Assessment of delirium in children admitted into the Intensive Care Unit: psCAM-ICU Tool

2020 ◽  
Vol 38 (2) ◽  
pp. 140-148
Author(s):  
Ángela María Henao Castaño ◽  
Edwar Yamith Pinzon Casas
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Primary Diagnosis ◽  
Critically Ill Children ◽  
Associated Risk Factors ◽  
Prolonged Hospital

Background: Delirium has been identified as a risk factor for the mortality of critically ill patients, generating great social and economic impacts, since patients require more days of mechanical ventilation and a prolonged hospital stay in the intensive care unit (ICU), thus increasing medical costs. Objective: To describe the prevalence and characteristics of delirium episodes in a sample of 6-month to 5-year-old children who are critically ill. Methods: Cohort study at a Pediatric Intensive Care Unit (PICU) in Bogotá (Colombia). Participants were assessed by the Preschool Confusion Assessment Method for the ICU (psCAM-ICU) within the first twenty-four hours of hospitalization. Results: One quarter of the participants (25.8%) presented some type of delirium. Among them, two sub-types of delirium were observed: 62.5% of the cases were hypoactive and 37.5% hyperactive. Moreover, from them, six were male (75%) and 2 female (25%). Primary diagnosis was respiratory tract infection in 62.55% of the patients, while respiratory failure was diagnosed in the remaining 37.5%. Conclusions: The implementation of delirium monitoring tools in critically ill children provides a better understanding of the clinical manifestation of this phenomenon and associated risk factors in order to contribute to the design of efficient intervention strategies.

scholarly journals Preoperative Cognitive Abnormality, Intraoperative Electroencephalogram Suppression, and Postoperative Delirium

2020 ◽  
Vol 132 (6) ◽  
pp. 1458-1468 ◽  
Author(s):  
Bradley A. Fritz ◽  
Christopher R. King ◽  
Arbi Ben Abdallah ◽  
Nan Lin ◽  
Angela M. Mickle ◽  
...  
Keyword(s):  
Effect Size ◽  
Postoperative Delirium ◽  
Medical Center ◽  
Academic Medical Center ◽  
Secondary Analysis ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Total Effect ◽  
Academic Medical ◽  
Cognitive Abnormality

Abstract Background Postoperative delirium is a common complication that hinders recovery after surgery. Intraoperative electroencephalogram suppression has been linked to postoperative delirium, but it is unknown if this relationship is causal or if electroencephalogram suppression is merely a marker of underlying cognitive abnormalities. The hypothesis of this study was that intraoperative electroencephalogram suppression mediates a nonzero portion of the effect between preoperative abnormal cognition and postoperative delirium. Methods This is a prespecified secondary analysis of the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) randomized trial, which enrolled patients age 60 yr or older undergoing surgery with general anesthesia at a single academic medical center between January 2015 and May 2018. Patients were randomized to electroencephalogram-guided anesthesia or usual care. Preoperative abnormal cognition was defined as a composite of previous delirium, Short Blessed Test cognitive score greater than 4 points, or Eight Item Interview to Differentiate Aging and Dementia score greater than 1 point. Duration of intraoperative electroencephalogram suppression was defined as number of minutes with suppression ratio greater than 1%. Postoperative delirium was detected via Confusion Assessment Method or chart review on postoperative days 1 to 5. Results Among 1,113 patients, 430 patients showed evidence of preoperative abnormal cognition. These patients had an increased incidence of postoperative delirium (151 of 430 [35%] vs.123 of 683 [18%], P < 0.001). Of this 17.2% total effect size (99.5% CI, 9.3 to 25.1%), an absolute 2.4% (99.5% CI, 0.6 to 4.8%) was an indirect effect mediated by electroencephalogram suppression, while an absolute 14.8% (99.5% CI, 7.2 to 22.5%) was a direct effect of preoperative abnormal cognition. Randomization to electroencephalogram-guided anesthesia did not change the mediated effect size (P = 0.078 for moderation). Conclusions A small portion of the total effect of preoperative abnormal cognition on postoperative delirium was mediated by electroencephalogram suppression. Study precision was too low to determine if the intervention changed the mediated effect. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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.

Delirium in Trauma Patients: Prevalence and Predictors

2017 ◽  
Vol 37 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Kathryn T. Von Rueden ◽  
Breighanna Wallizer ◽  
Paul Thurman ◽  
Karen McQuillan ◽  
Tiffany Andrews ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Vision Loss ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Costs ◽  
Assessment Method ◽  
Trauma Patients ◽  
Intermediate Care

BACKGROUNDDelirium is associated with increased mortality, morbidity, hospital costs, and postdischarge cognitive dysfunction. Most research focuses on nontrauma patients receiving mechanical ventilation in the intensive care unit.OBJECTIVESTo determine the prevalence and predictors of delirium in trauma patients residing in intensive and intermediate care units of an academic medical center.METHODSTrauma patients were screened for delirium by using the Confusion Assessment Method for the Intensive Care Unit. Exclusion criteria included documented brain injury, history of psychosis or cognitive impairment, not speaking English, and hearing or vision loss.RESULTSOf the 215 study patients, 24% were positive for delirium; 36% of patients in the intensive care unit and 11% of patients in the intermediate care unit. Delirium-positive patients were older (mean age, 53.4 years) than patients who were not (mean age, 44 years; P = .004). Although mechanical ventilation (odds ratio, 4.73, P = .004) was the strongest independent risk factor for delirium, 12% of delirium-positive patients were not receiving mechanical ventilation. Other predictors of delirium were use of antipsychotic medications, higher scores on the Acute Physiology and Chronic Health Evaluation III, and lower scores on the Richmond Agitation-Sedation Scale.CONCLUSIONSPatients in both the intermediate and intensive care units, whether mechanical ventilation was used or not, were positive for delirium. Delirium prevention protocols may benefit trauma patients regardless of their inpatient location.

Decreasing Inappropriate Unable-to-Assess Ratings for the Confusion Assessment Method for the Intensive Care Unit

2014 ◽  
Vol 23 (1) ◽  
pp. 60-69 ◽  
Author(s):  
Joshua T. Swan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Odds Ratio ◽  
Academic Medical Center ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment ◽  
Surgical Icu ◽  
Educational Campaign ◽  
To Receive

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.

Sign in / Sign up

Export Citation Format

Share Document