Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

Perioperative delirium is a wide-ranging problem that directly affects primary clinical results. The anesthesiologist must understand how to define and diagnose delirium, identify patients at high risk of delirium, identify predisposing factors to adjust the care plan appropriately, and manage delirium in the acute postoperative period. Delirium is an organ dysfunction in critically ill patients, independently associated with improved morbidity. Research on delirium in hospitalized patients (including critically ill patients) has increased exponentially in the last decade. This study emphasizes the need for a mechanistic explanation of delirium to help advance the research that ultimately leads to its prevention and treatment. In this study, multinational and multidisciplinary clinicians, and researchers from the fields of critical care medicine, psychiatry, anesthesiology, neurology, and pharmacy sought to collaborate in the management of delirium in the intensive care unit (ICU).

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Sedation, Pain Management, and Pharmacology

Anesthesiology Critical Care Board Review ◽

10.1093/med/9780190908041.003.0007 ◽

2019 ◽

pp. 87-99

Author(s):

Sophie Samuel ◽

Jennifer Cortes

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Pain Management ◽

Infectious Diseases ◽

Operating Room ◽

Critically Ill ◽

Residency Training ◽

Critically Ill Patients ◽

Clinical Vignettes

The study of pharmacology enables the principle method of intervention for critically ill patients. Because many variables exists that affect the efficacy and indications for drug intervention, a thorough knowledge of pharmacology is needed in the intensive care unit, just as it is needed in the operating room. Because pharmacology effects every system it may potentially be included in every type of question. In order to achieve a pharmacologic focus, much of this chapter emphasizes and infrequently seen but non-isoteric contact. Overall, chapter is designed to evaluate pharmacologic knowledge with highly clinical vignettes for the reader. Additionally, the reader will find an emphasis on practice pharmacologic elements of managing infectious diseases and complexities of sedation, which anesthesiologists will find reminiscent of the residency training with a critical care “twist”.

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Transfusion Requirements in Critical Care (TRICC)

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0022 ◽

2018 ◽

pp. 114-118

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Cardiac Ischemia ◽

Red Cell ◽

Transfusion Threshold ◽

Chronic Anemia ◽

Transfusion Requirements

This case focuses on red cell transfusions in critically ill patients by asking the question: When should patients in the intensive care unit (ICU) with anemia receive red cell transfusions? For most critically ill patients, waiting to transfuse red cells until the hemoglobin (Hgb) drops below 7 g/dL is at least as effective as, and likely preferable to, transfusing at an Hgb less than 10 g/dL. These findings may not apply to patients with chronic anemia, who were excluded from the trial. The results also may not apply to patients with active cardiac ischemia, who were poorly represented in the trial and had nonsignificantly worse outcomes with a transfusion threshold of 7.

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The simple observational critical care studies: estimations by students, nurses, and physicians of in-hospital and 6-month mortality

Critical Care ◽

10.1186/s13054-021-03809-w ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Eline G. M. Cox ◽

Marisa Onrust ◽

Madelon E. Vos ◽

Wolter Paans ◽

Willem Dieperink ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Decision Making ◽

Operating Characteristics ◽

Tertiary Teaching ◽

Nurses And Physicians

Abstract Background Prognostic assessments of the mortality of critically ill patients are frequently performed in daily clinical practice and provide prognostic guidance in treatment decisions. In contrast to several sophisticated tools, prognostic estimations made by healthcare providers are always available and accessible, are performed daily, and might have an additive value to guide clinical decision-making. The aim of this study was to evaluate the accuracy of students’, nurses’, and physicians’ estimations and the association of their combined estimations with in-hospital mortality and 6-month follow-up. Methods The Simple Observational Critical Care Studies is a prospective observational single-center study in a tertiary teaching hospital in the Netherlands. All patients acutely admitted to the intensive care unit were included. Within 3 h of admission to the intensive care unit, a medical or nursing student, a nurse, and a physician independently predicted in-hospital and 6-month mortality. Logistic regression was used to assess the associations between predictions and the actual outcome; the area under the receiver operating characteristics (AUROC) was calculated to estimate the discriminative accuracy of the students, nurses, and physicians. Results In 827 out of 1,010 patients, in-hospital mortality rates were predicted to be 11%, 15%, and 17% by medical students, nurses, and physicians, respectively. The estimations of students, nurses, and physicians were all associated with in-hospital mortality (OR 5.8, 95% CI [3.7, 9.2], OR 4.7, 95% CI [3.0, 7.3], and OR 7.7 95% CI [4.7, 12.8], respectively). Discriminative accuracy was moderate for all students, nurses, and physicians (between 0.58 and 0.68). When more estimations were of non-survival, the odds of non-survival increased (OR 2.4 95% CI [1.9, 3.1]) per additional estimate, AUROC 0.70 (0.65, 0.76). For 6-month mortality predictions, similar results were observed. Conclusions Based on the initial examination, students, nurses, and physicians can only moderately predict in-hospital and 6-month mortality in critically ill patients. Combined estimations led to more accurate predictions and may serve as an example of the benefit of multidisciplinary clinical care and future research efforts.

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Electroencephalogram Monitoring in Critical Care

Seminars in Neurology ◽

10.1055/s-0040-1719073 ◽

2020 ◽

Vol 40 (06) ◽

pp. 675-680

Author(s):

Clio Rubinos ◽

Ayham Alkhachroum ◽

Caroline Der-Nigoghossian ◽

Jan Claassen

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Critical Care Unit ◽

Care Setting ◽

Eeg Monitoring ◽

Electroencephalogram Eeg ◽

Brain Monitoring

AbstractSeizures are common in critically ill patients. Electroencephalogram (EEG) is a tool that enables clinicians to provide continuous brain monitoring and to guide treatment decisions—brain telemetry. EEG monitoring has particular utility in the intensive care unit as most seizures in this setting are nonconvulsive. Despite the increased use of EEG monitoring in the critical care unit, it remains underutilized. In this review, we summarize the utility of EEG and different EEG modalities to monitor patients in the critical care setting.

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Turning up the heat on fever research?

Critical Care and Resuscitation ◽

10.51893/2021.1.ed1 ◽

2021 ◽

Vol 23 (1) ◽

pp. 4-5

Author(s):

Paul J Young ◽

◽

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Body Temperature ◽

Critically Ill ◽

Critically Ill Patients ◽

Temperature Management ◽

Clinical Decisions ◽

Considerable Effort

Intensive care unit (ICU) clinicians expend considerable effort measuring and manipulating body temperature in critically ill patients. A great deal of anxiety is expended worrying about both fever and hypothermia, and yet, the evidence to support clinical decisions about temperature management is limited. In this issue of Critical Care and Resuscitation, investigators have gone back to the basics with three studies that turn up the heat on fever research.

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Intensive Care Unit Scoring Systems

Critical Care Nurse ◽

10.4037/ccn2021613 ◽

2021 ◽

Vol 41 (4) ◽

pp. 54-64

Author(s):

Tiffany Purcell Pellathy ◽

Michael R. Pinsky ◽

Marilyn Hravnak

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Scoring Systems ◽

Multiple Organ Dysfunction Score ◽

Severity Scoring ◽

Logistic Organ Dysfunction

Background Illness severity scoring systems are commonly used in critical care. When applied to the populations for whom they were developed and validated, these tools can facilitate mortality prediction and risk stratification, optimize resource use, and improve patient outcomes. Objective To describe the characteristics and applications of the scoring systems most frequently applied to critically ill patients. Methods A literature search was performed using MEDLINE to identify original articles on intensive care unit scoring systems published in the English language from 1980 to 2020. Search terms associated with critical care scoring systems were used alone or in combination to find relevant publications. Results Two types of scoring systems are most frequently applied to critically ill patients: those that predict risk of in-hospital mortality at the time of intensive care unit admission (Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score, and Mortality Probability Models) and those that assess and characterize current degree of organ dysfunction (Multiple Organ Dysfunction Score, Sequential Organ Failure Assessment, and Logistic Organ Dysfunction System). This article details these systems’ differing features and timing of use, score calculation, patient populations, and comparative performance data. Conclusion Critical care nurses must be aware of the strengths, limitations, and specific characteristics of severity scoring systems commonly used in intensive care unit patients to effectively employ these tools in clinical practice and critically appraise research findings based on their use.

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Predictors of Pressure Ulcers in Adult Critical Care Patients

American Journal of Critical Care ◽

10.4037/ajcc2011934 ◽

2011 ◽

Vol 20 (5) ◽

pp. 364-375 ◽

Cited By ~ 149

Author(s):

Jill Cox

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Pressure Ulcers ◽

Critical Care Patients

BackgroundPressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate. Currently, consensus is lacking on the most important risk factors for pressure ulcers in critically ill patients, and no risk assessment scale exclusively for pressure ulcers in these patients is available.ObjectiveTo determine which risk factors are most predictive of pressure ulcers in adult critical care patients. Risk factors investigated included total score on the Braden Scale, mobility, activity, sensory perception, moisture, friction/shear, nutrition, age, blood pressure, length of stay in the intensive care unit, score on the Acute Physiology and Chronic Health Evaluation II, vasopressor administration, and comorbid conditions.MethodsA retrospective, correlational design was used to examine 347 patients admitted to a medical-surgical intensive care unit from October 2008 through May 2009.ResultsAccording to direct logistic regression analyses, age, length of stay, mobility, friction/shear, norepinephrine infusion, and cardiovascular disease explained a major part of the variance in pressure ulcers.ConclusionCurrent risk assessment scales for development of pressure ulcers may not include risk factors common in critically ill adults. Development of a risk assessment model for pressure ulcers in these patients is warranted and could be the foundation for development of a risk assessment tool.

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Emotional responses of family members during a critical care hospitalization

American Journal of Critical Care ◽

10.4037/ajcc1994.3.1.70 ◽

1994 ◽

Vol 3 (1) ◽

pp. 70-76 ◽

Cited By ~ 62

Author(s):

C Kleiber ◽

M Halm ◽

M Titler ◽

LA Montgomery ◽

SK Johnson ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Emotional Response ◽

Family Members ◽

Emotional Responses ◽

Nursing Interventions ◽

Supportive Behaviors

BACKGROUND: The needs and satisfaction levels of family members of critically ill patients have received much attention in the literature. The feelings of family members, however, have not been thoroughly investigated. To develop appropriate nursing interventions to assist family members in coping with a critical care hospitalization, accurate information about their emotional response to the situation is needed. OBJECTIVE: To examine emotional responses of family members and their descriptions of supportive behaviors of others during a critical care hospitalization. METHODS: An exploratory design was used to study 52 subjects with critically ill family members in the pediatric, neonatal, medical, surgical and cardiovascular intensive care units in a large tertiary care hospital. The subjects kept daily logs of their feelings and the supportive behaviors of others. Thematic analysis was used to identify major themes. RESULTS: Analysis revealed a broad range of powerful emotions throughout the intensive care unit stay. Negative and positive emotions such as despair and joy were sometimes identified by subjects within a 24-hour period. Although fear, worry, anger and exhaustion were dominant themes during the first 24 hours and when the family received bad news about the patient, there was no pattern of emotional response evident as the stay progressed. Some differences between subjects drawn from the medical and neonatal intensive care units were evident. CONCLUSIONS: The findings suggest that family members of critically ill patients experience deep emotional turmoil throughout the intensive care unit stay. Specific nursing interventions to promote adaptive coping are needed throughout the experience.

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Turning up the heat on fever research?

Critical Care and Resuscitation ◽

10.51893/2021.1.sr1 ◽

2021 ◽

Vol 23 (1) ◽

pp. 4-5

Author(s):

Paul Young ◽

◽

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Body Temperature ◽

Critically Ill ◽

Critically Ill Patients ◽

Temperature Management ◽

Clinical Decisions ◽

Considerable Effort

Intensive care unit (ICU) clinicians expend considerable effort measuring and manipulating body temperature in critically ill patients. A great deal of anxiety is expended worrying about both fever and hypothermia, and yet, the evidence to support clinical decisions about temperature management is limited. In this issue of Critical Care and Resuscitation, investigators have gone back to the basics with three studies that turn up the heat on fever research

Download Full-text