For older adults admitted to general (non-intensive care unit [ICU]) hospital settings, what are the effects of multi-component delirium prevention interventions?

2021 ◽  
Author(s):  
Jane Burch ◽  
Gregor Veninšek
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Prevention Interventions ◽  
Delirium Prevention

Delirium prevention program in the surgical intensive care unit improved the outcomes of older adults

2014 ◽  
Vol 190 (1) ◽  
pp. 280-288 ◽  
Author(s):  
Sarah B. Bryczkowski ◽  
Maeve C. Lopreiato ◽  
Peter P. Yonclas ◽  
James J. Sacca ◽  
Anne C. Mosenthal
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Prevention Program ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Delirium Prevention

scholarly journals Evaluation of a Continuous Decontamination Technology in an Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s519-s519
Author(s):  
Tami Inman BSN ◽  
David Chansolme
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Urban Hospital ◽  
Patient Room ◽  
Colony Forming Units ◽  
Prevention Interventions ◽  
Continuous Application ◽  
Low Levels ◽  
Healthcare Associated ◽  
Cleaning And Disinfection

Background: The scientific literature increasingly indicates the need for the development of continuous disinfection to address the persistent contamination and recontamination that occurs in the patient rooms despite routine cleaning and disinfection. Methods: To determine a baseline microbial burden level on patient room surfaces in the intensive care unit (ICU) of a large urban hospital, 50 locations were swabbed for total colony-forming units (CFU) and the prevalence of methicillin-resistant Staphylococcus aureus (MRSA). Once the baseline in ICU patient rooms was established, 5 novel decontamination devices were installed in the HVAC ducts near these patient rooms. The devices provide a continuous low-level application of oxidizing molecules, predominately hydrogen peroxide. These molecules exit the duct and circulate in the patient room through normal convection, landing on all surfaces. After activation, environmental sampling was conducted every 4 weeks for 4 months. The effect from continuous low levels of oxidizing molecules on the intrinsic microbial burden and the prevalence of MRSA were analyzed. In addition to external laboratory reports, the facility tracked healthcare-associated infections (HAIs) in the unit. HAI data were averaged by month and were compared to the preactivation average in the same unit. Results: The preactivation average microbial burden found on the 50 locations were 179,000 CFU per 100 in2. The prevalence of MRSA was 71% with an average of 81 CFU per 100 in2. After activation of the devices, levels of microbial burden, prevalence of MRSA, and average monthly HAI rates were all significantly lower on average: 95% reduction in average microbial burden (8,206 CFU per 100 in2); 81% reduction in the prevalence of MRSA (13% vs 71%); 54% reduction in the average of healthcare-onset HAIs. All data were obtained from the averages of sampling data for 4 weeks during the 4-month trial period. Conclusions: The continuous application of low levels of oxidizing molecules throughout the patient rooms of an ICU demonstrated 3 outcomes: reduced overall surface microbial burden, lowered the incidence of MRSA, and significantly decreased the monthly average HAI rate. Please note, the ICU ran other infection prevention interventions at this time, including standard cleaning, as well as and their standard disinfecting techniques.Funding: This study was supported by the CASPR Group.Disclosures: None

scholarly journals Defining the Role of Dexmedetomidine in the Prevention of Delirium in the Intensive Care Unit

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
S. Nelson ◽  
A. J. Muzyk ◽  
M. H. Bucklin ◽  
S. Brudney ◽  
J. P. Gagliardi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Outcome Measure ◽  
Inclusion Criteria ◽  
Respiratory Compromise ◽  
Ongoing Research ◽  
Cochrane Database ◽  
Delirium Prevention ◽  
Sedation Regimen

Dexmedetomidine is a highly selectiveα2agonist used as a sedative agent. It also provides anxiolysis and sympatholysis without significant respiratory compromise or delirium. We conducted a systematic review to examine whether sedation of patients in the intensive care unit (ICU) with dexmedetomidine was associated with a lower incidence of delirium as compared to other nondexmedetomidine sedation strategies. A search of PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews yielded only three trials from 1966 through April 2015 that met our predefined inclusion criteria and assessed dexmedetomidine and outcomes of delirium as their primary endpoint. The studies varied in regard to population, comparator sedation regimen, delirium outcome measure, and dexmedetomidine dosing. All trials are limited by design issues that limit our ability definitively to conclude that dexmedetomidine prevents delirium. Evidence does suggest that dexmedetomidine may allow for avoidance of deep sedation and use of benzodiazepines, factors both observed to increase the risk for developing delirium. Our assessment of currently published literature highlights the need for ongoing research to better delineate the role of dexmedetomidine for delirium prevention.

Abstract 301: Differential Outcomes for Geriatric Patients in Cardiac Intensive Care Unit Compared to Medical Intensive Care Unit

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Caroline Ong ◽  
Albert Lui ◽  
John A Dodson ◽  
Jordan B Strom ◽  
Carlos Alviar
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Center ◽  
Older Age ◽  
Icu Mortality ◽  
Differential Outcomes ◽  
Medical Intensive Care ◽  
Cardiac Intensive Care

Background: The number of older adults admitted to cardiac intensive care units (CICU) have been increasing over the past decade, but it is not known if outcomes vary between CICU and medical intensive care units (MICU). We aimed to describe survival and length of stay (LOS) in older adults admitted to CICU and MICU. Methods: All patients admitted to the CICU or MICU at Beth Israel Deaconess Medical Center from 2001-2012 were identified from MIMIC-III, a large single-center critical care database containing deidentified clinical data for 38,597 patients. Our primary outcomes were ICU mortality and ICU LOS. Regression analyses were performed adjusting for age, gender, ICU setting and Oxford Acute Severity of Illness Score (OASIS), a severity score developed and validated in critically ill patients for ICU mortality. Results: We included 21,088 MICU patients (48.3% female) and 7,726 CICU patients (42% female). Unadjusted mortality was 13.7% in MICU and 12.5% in CICU (p=0.11). When adjusted for age, gender and OASIS, there was no difference in mortality between MICU and CICU (OR 0.62, 95% CI 0.34-1.13, p=0.15). However, we found a significant interaction between older age and type of ICU with mortality (p=0.03) but not with ICU LOS (p=0.15). In patients >75 years (6,837 in MICU and 3,161 in CICU), each 5-year interval of older age was associated with higher mortality when adjusted for gender and OASIS in the CICU (OR 1.05, 95% CI 1.02-1.08 p=0.002), but not in the MICU (OR 1.01, 95% CI 0.99-1.03, p=0.15, Figure). Conclusion: Older adults admitted to the CICU had higher adjusted mortality by age group after age 75, as opposed to older MICU patients in whom mortality was high but remained unchanged after age 75.

Executive Function, Dexterity, and Discharge Disposition in Older Intensive Care Unit Survivors

2020 ◽  
Vol 29 (6) ◽  
pp. 484-488
Author(s):  
Maya N. Elías ◽  
Cindy L. Munro ◽  
Zhan Liang
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Executive Function ◽  
Cognitive Flexibility ◽  
Motor Coordination ◽  
Functional Decline ◽  
Dimensional Change ◽  
Fine Motor ◽  
Discharge Disposition

Background Dexterity is a component of motor function. Executive function, a subdomain of cognition, may affect dexterity in older adults recovering from critical illness after discharge from an intensive care unit (ICU). Objectives To explore associations between executive function (attention and cognitive flexibility) and dexterity (fine motor coordination) in the early post-ICU period and examine dexterity by acuity of discharge disposition. Methods The study involved 30 older adults who were functionally independent before hospitalization, underwent mechanical ventilation in the ICU, and had been discharged from the ICU 24 to 48 hours previously. Dexterity was evaluated with the National Institutes of Health Toolbox (NIHTB) Motor Battery 9-Hole Pegboard Dexterity Test (PDT); attention, with the NIHTB Cognition Battery Flanker Inhibitory Control and Attention Test (FICAT); and cognitive flexibility, with the NIHTB Cognition Battery Dimensional Change Card Sort Test (DCCST). Exploratory regression was used to examine associations between executive function and dexterity (fully corrected T scores). Independent-samples t tests were used to compare dexterity between participants discharged home and those discharged to a facility. Results FICAT (β = 0.375, P = .03) and DCCST (β = 0.698, P = .001) scores were independently and positively associated with PDT scores. Further, PDT scores were worse among participants discharged to a facility than among those discharged home (mean [SD], 26.71 [6.14] vs 36.33 [10.30]; t24 = 3.003; P = .006). Conclusions Poor executive function is associated with worse dexterity; thus, dexterity may be a correlate of both post-ICU cognitive impairment and functional decline. Performance on dexterity tests could identify frail older ICU survivors at risk for worse discharge outcomes.

scholarly journals Level of acuity, severity and intensity of care of adults and older adults admitted to the Intensive Care Unit

2019 ◽  
Vol 53 ◽  
Author(s):  
Renata Eloah de Lucena Ferretti-Rebustini ◽  
Nilmar da Silva Bispo ◽  
Winnie da Silva Alves ◽  
Thiago Negreiro Dias ◽  
Cristiane Moretto Santoro ◽  
...  
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Group Method ◽  
Predictive Capacity ◽  
Organic Dysfunction ◽  
Intensity Of Care ◽  
Correlation Tests ◽  
The City

ABSTRACT Objective: To characterize the level of acuity, severity and intensity of care of adults and older adults admitted to Intensive Care Units and to identify the predictors of severity with their respective predictive capacity according to the age group. Method: A retrospective cohort based on the analysis of medical records of individuals admitted to eight adult intensive care units in the city of São Paulo. The clinical characteristics at admission in relation to severity profile and intensity of care were analyzed through association and correlation tests. The predictors were identified by linear regression and the predictive capacity through the ROC curve. Results: Of the 781 cases (41.1% from older adults), 56.2% were males with a mean age of 54.1 ± 17.3 years. The burden of the disease, the organic dysfunction and the number of devices were the predictors associated with greater severity among adults and older adults, in which the organic dysfunction had the highest predictive capacity (80%) in both groups. Conclusion: Adults and older adults presented a similar profile of severity and intensity of care in admission to the Intensive Care Unit. Organic dysfunction was the factor with the best ability to predict severity in adults and older adults.

scholarly journals Older Adults With Isolated Rib Fractures Do Not Require Routine Intensive Care Unit Admission

2020 ◽  
Vol 245 ◽  
pp. 492-499 ◽  
Author(s):  
Jessica A. Bowman ◽  
Gregory J. Jurkovich ◽  
Daniel K. Nishijima ◽  
Garth H. Utter
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Rib Fractures
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