OT and the Management of ICU Delirium

Background: Patients with acute respiratory distress syndrome (ARDS) are highly susceptible to developing delirium for a multitude of reasons. Previous studies have linked pre-existing depression with an increased risk of postoperative delirium in patients undergoing cardiac and non-cardiac surgery. However, the evidence regarding the association between pre-existing psychiatric illnesses and delirium in ARDS patients is unknown. In this study, we aim to determine the relationship between pre-existing psychiatric illness and the risk of development of delirium amongst ARDS patients. Study Design and Methods: We performed a retrospective study of a mixed group of patients admitted to the intensive care unit (ICU) between January 2016 and December 2019 with a diagnosis of ARDS per the Berlin definition. The study group was divided into 2 cohorts: subjects with delirium and subjects without delirium. Comparison between the 2 groups was conducted to examine the impact of pre-existing psychiatric illnesses including major depressive disorder (MDD), generalized anxiety disorder (GAD), bipolar disorder, schizophrenia, or post-traumatic stress disorder. Multivariable logistic regression analysis was performed adjusting for benzodiazepine use, sedatives, analgesics, sequential organ failure assessment score, and corticosteroid use to determine the association between pre-existing psychiatric disorders and delirium. Results: 286 patients with ARDS were identified; 124 (43%) of whom were diagnosed with ICU delirium. In patients diagnosed with ICU delirium, 49.2% were found to have preexisting psychiatric illnesses, compared to 34.0% without any preexisting psychiatric illness (OR = 1.94, P = 0.01). In a subgroup analysis of individual psychiatric illnesses, GAD and MDD were associated with the development of delirium (OR = 1.88, P = 0.04 and OR = 1.76, P = 0.05 respectively). Interpretation: ARDS patients with preexisting psychiatric illnesses, particularly GAD and MDD are associated with an increased risk of developing ICU delirium. Clinicians should be aware of the effect of psychiatric co-morbidities on developing delirium in critically ill patients.

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Surgical intensive care unit (ICU) delirium: A “psychosomatic” problem?

Palliative & Supportive Care ◽

10.1017/s1478951509990964 ◽

2010 ◽

Vol 8 (2) ◽

pp. 221-225 ◽

Cited By ~ 4

Author(s):

Michel Reich ◽

Regis Rohn ◽

Daniele Lefevre

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Psychological Factors ◽

Death Anxiety ◽

Defense Mechanism ◽

Cognitive Disorders ◽

Major Surgery ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Icu Delirium

AbstractObjective:Intensive Care Unit (ICU) delirium is a common complication after major surgery and related among other potential medical precipitants to either pre-existing cognitive impairment or the intensity and length of anesthesiology or the type of surgery. Nevertheless, in some rare situations, an organic etiology is not always found, which can be frustrating for the medical team. Some clinicians working in an intensive care unit have a reluctance to seek another hypothesis in the psychological field.Method:To illustrate this, we report the case of a 59-year-old woman who developed a massive delirium during her intensive care unit stay after being operated on for a left retroperitoneal sarcoma. Interestingly, she had had no previous cognitive disorders and a somatic explanation for her psychiatric disorder could not been found. Just before the surgery, she was grieving the recent loss of a colleague of the same age, and also a close friend, and therefore had a death anxiety.Results:With this case report, we would like to point out the importance of psychological factors that might precipitate delirium in a predominately somatic environment such as an intensive care unit.Significance of results:ICU delirium can sometimes be considered as a “psychosomatic” problem with either a stress response syndrome after surgery or a defense mechanism against death anxiety. Clinicians should be aware of the possibility of such psychological factors even if they always must first rule out potential somatic causes for delirium and encourage thorough investigation and treatment of these medical causes. A collaboration with the psycho-oncologist is recommended to better manage this “psychosomatic” problem.

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925: EVALUATION OF RAMELTEON FOR THE REDUCTION OF ICU DELIRIUM

Critical Care Medicine ◽

10.1097/01.ccm.0000528932.76383.2d ◽

2018 ◽

Vol 46 (1) ◽

pp. 446-446

Author(s):

Whitney Gibson ◽

Melissa Giarratano ◽

Maresa Glass

Keyword(s):

Icu Delirium

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The Cost of ICU Delirium and Coma in the Intensive Care Unit Patient

Medical Care ◽

10.1097/mlr.0000000000000975 ◽

2018 ◽

Vol 56 (10) ◽

pp. 890-897 ◽

Cited By ~ 24

Author(s):

Eduard E. Vasilevskis ◽

Rameela Chandrasekhar ◽

Colin H. Holtze ◽

John Graves ◽

Theodore Speroff ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Patient ◽

Icu Delirium ◽

The Cost

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Gender differences in the use of atypical antipsychotic medications for ICU delirium

Critical Care ◽

10.1186/s13054-018-2143-5 ◽

2018 ◽

Vol 22 (1) ◽

Cited By ~ 1

Author(s):

Kunal Karamchandani ◽

Robert S. Schoaps ◽

Jillian Printz ◽

Jeffrey M. Kowaleski ◽

Zyad J. Carr

Keyword(s):

Gender Differences ◽

Atypical Antipsychotic ◽

Antipsychotic Medications ◽

Icu Delirium ◽

Atypical Antipsychotic Medications

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Prescribing Practices of Valproic Acid for Agitation and Delirium in the Intensive Care Unit

Annals of Pharmacotherapy ◽

10.1177/1060028020947173 ◽

2020 ◽

pp. 106002802094717

Author(s):

Nicholas J. Quinn ◽

Benjamin Hohlfelder ◽

Matthew R. Wanek ◽

Abhijit Duggal ◽

Heather Torbic

Keyword(s):

Intensive Care Unit ◽

Valproic Acid ◽

Intensive Care ◽

Primary Objective ◽

Assessment Tools ◽

Prescribing Practices ◽

Dose Frequency ◽

Institutional Review ◽

Alternative Treatment Option ◽

Icu Delirium

Background: Analgesics, sedatives, and antipsychotics are commonly prescribed for agitation and delirium in the intensive care unit (ICU), but their use is limited by adverse effects and lack of efficacy. Valproic acid is an alternative treatment option. Objective: The primary objective of this study was to describe valproic acid prescribing in our institution’s ICUs when used for agitation or delirium. Measures of effectiveness and safety were also assessed. Methods: This was a single-center, retrospective, institutional review board–approved cohort study of adult inpatients admitted to the ICU between January 2018 and August 2018. Patients who received valproic acid for the treatment of agitation or delirium for ≥24 hours were included. Prescribing practices were evaluated for dose, frequency, and route of administration. Effectiveness was assessed via agitation and delirium assessment tools and quantity of adjunctive agents used. Results: A total of 80 patients were included, with 35 receiving valproic acid alone and 45 in conjunction with antipsychotics. The most common valproic acid regimen was 250 mg orally 3 times daily. Delirium resolution occurred in 55% of patients: 24 in the valproic acid monotherapy group and 20 in the valproic acid plus antipsychotic group (69% vs 44%; P = 0.03). The incidence of delirium decreased from valproic acid day 0 to day 3 (93% vs 68%; P < 0.01), with no change in agitation (64% vs 63%; P = 0.28). Conclusion and Relevance: Valproic acid is frequently prescribed in agitated, delirious patients at our institution and may have a role in the management of ICU delirium.

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953: CLINICAL IMPACT OF PHARMACIST ASSESSMENT IN PATIENTS WITH ICU DELIRIUM

Critical Care Medicine ◽

10.1097/01.ccm.0000528960.86693.21 ◽

2018 ◽

Vol 46 (1) ◽

pp. 460-460

Author(s):

Maresa Glass ◽

Whitney Gibson

Keyword(s):

Clinical Impact ◽

Icu Delirium

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Prevention of ICU delirium and delirium-related outcome with haloperidol: a study protocol for a multicenter randomized controlled trial

Trials ◽

10.1186/1745-6215-14-400 ◽

2013 ◽

Vol 14 (1) ◽

pp. 400 ◽

Cited By ~ 13

Author(s):

Mark van den Boogaard ◽

Arjen J Slooter ◽

Roger JM Brüggemann ◽

Lisette Schoonhoven ◽

Michael A Kuiper ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Study Protocol ◽

Controlled Trial ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial ◽

Icu Delirium

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Physical and Occupational Therapy in the ICU

10.1093/med/9780199653461.003.0043 ◽

2014 ◽

Author(s):

William D Schweickert ◽

John P Kress

Keyword(s):

Occupational Therapy ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Respiratory Therapists ◽

Underlying Illness ◽

Time Periods ◽

Icu Delirium ◽

Therapy Team ◽

Icu Acquired Weakness ◽

Ventilated Patients

Mechanically ventilated patients in the ICU are commonly immobilized for prolonged time periods due to factors that include the underlying illness, encephalopathy, or sedation. In this setting, severe ICU-acquired weakness is common and may represent both a cause and consequence of immobilization. Physical and occupational therapy is feasible in ICU patients, even very early during mechanical ventilation. This intervention requires a coordinated effort between physicians, nurses, respiratory therapists, and the physical/occupational therapy team. Early physical and occupational therapy can lead to improved strength and functional status, reduced ventilator days and length of stay, and fewer days of ICU delirium.

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