scholarly journals Νοσηλευτική προσέγγιση ασθενών με delirium μετά από καρδιοχειρουργική επέμβαση

2015 ◽  
Author(s):  
Ηλίας Τσαγγαλάς
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Assessment Method ◽  
Nursing Delirium Screening Scale ◽  
Screening Scale

Το οξύ μετεγχειρητικό οργανικό ψυχοσύνδρομο (delirium) αποτελεί συχνή επιπλοκή μετά από καρδιοχειρουργικές επεμβάσεις. Χαρακτηρίζεται από αποπροσανατολισμό του ασθενούς, συχνότερα στη Μονάδα Εντατικής Θεραπείας, ως προς τον χώρο και το χρόνο, πολλές φορές συνοδευόμενο από επιθετική ή αυτοκαταστροφική συμπεριφορά. Σκοπός της παρούσης μελέτης είναι η έρευνα της επίδρασης-αποτελεσματικότητας συγκεκριμένων νοσηλευτικών παρεμβάσεων στην αντιμετώπιση του παραληρήματος.Υλικό και Μέθοδος. Συμπεριλάβαμε στη μελέτη 47 ασθενείς που εμφάνισαν delirium επί συνόλου 184 ασθενών που συνολικά υποβλήθηκαν σε μείζονα καρδιοχειρουργική επέμβαση (CABG, AVR, MVR, συνδυασμένες επεμβάσεις, Ανεύρυσμα και Διαχωρισμός Θωρακικής Αορτής) την αντίστοιχη περίοδο, διάρκειας 18 μηνών. Οι ασθενείς ελέγχθηκαν ως προς το σύνδρομο με τις κλίμακες CAM -ICU (Confusement Assessment Method for Intensive Care Unit) και Nu DeSc (Nursing Delirium Screening Scale). Στη συνέχεια χωρίστηκαν σε τέσσερις ομάδες: μία ομάδα ελέγχου χωρίς επιπλέον παρεμβάσεις, μία ομάδα στην οποία δόθηκε στους ασθενείς δυνατότητα για ακρόαση μουσικής για 20 λεπτά δύο φορές την ημέρα, μία ομάδα στην οποία εφαρμόστηκε επιπλέον πρόγραμμα φυσικοθεραπείας, και τέλος, μία ομάδα με δυνατότητα δύο επιπλέον επισκέψεων διαρκείας εικοσαλέπτου από οικείους, ημερησίως.Αποτελέσματα. Στη μελέτη συμμετείχαν 152 (83%) άνδρες και 32 (17%) γυναίκες. Ο μέσος όρος ηλικίας και των δύο φύλων χωρίς delirium ήταν 61.55±7.9 ετών και με delirium ήταν 68.97±8.1 ετών. Οι ασθενείς στους οποίους εφαρμόστηκαν υποστηρικτικές παρεμβάσεις είχαν βελτιωμένη συμπεριφορά ως προς το delirium με βάση τα αποτελέσματα στις κλίμακες μετρήσεως. Πιο συγκεκριμένα, οι ασθενείς με την ακρόαση μουσικής πριν την παρέμβαση είχαν μέσο όρο σε score 4.8±0.7 και μετά την παρέμβαση score 3.2±0.4 με (p< 0.01). Αυτοί της ομάδας φυσικοθεραπείας είχαν μέσο όρο σε score 4.7±0.6 και μετά την παρέμβαση score 3.6±0.4 με (p< 0.05). Τέλος αυτοί με τη δυνατότητα επιπλέον επισκεπτηρίου είχαν μέσο όρο σε score 5±0.7 και μετά την παρέμβαση score μέσο όρο 4.0±0.5 με (p< 0.05). Η διάρκεια του παραληρήματος υπήρξε πολύ μικρότερη στις ομάδες παρέμβασης σε σύγκριση με την ομάδα ελέγχου που δεν έλαβε παρέμβασης (32 ± 3, ± 36 4 και 38 ± 4 vs 48 ± 9 ώρες αντίστοιχα).Συμπεράσματα. Οι υποστηρικτικές, μη φαρμακευτικής φύσεως παρεμβάσεις, βοηθούν στη βελτίωση της εικόνας των ασθενών με delirium μετά από καρδιοχειρουργικές επεμβάσεις

scholarly journals Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

2021 ◽  
Author(s):  
Andrea Kirfel ◽  
Jan Menzenbach ◽  
Vera Guttenthaler ◽  
Johanna Feggeler ◽  
Andreas Mayr ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

scholarly journals Incidence of Delirium in Critically Ill Cancer Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Luis A. Sánchez-Hurtado ◽  
Nancy Hernández-Sánchez ◽  
Mario Del Moral-Armengol ◽  
Humberto Guevara-García ◽  
Francisco J. García-Guillén ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cancer Patients ◽  
Critically Ill ◽  
Potential Risk ◽  
Assessment Method ◽  
Icu Stay ◽  
Potential Risk Factors

Objective. The aim of this study was to estimate the incidence of delirium and its risk factors among critically ill cancer patients in an intensive care unit (ICU). Materials and Methods. This is a prospective cohort study. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was measured daily at morning to diagnose delirium by a physician. Delirium was diagnosed when the daily was positive during a patient’s ICU stay. All patients were followed until they were discharged from the ICU. Using logistic regression, we estimated potential risk factors for developing delirium. The primary outcome was the development of ICU delirium. Results. There were 109 patients included in the study. Patients had a mean age of 48.6 ± 18.07 years, and the main reason for admission to the ICU was septic shock (40.4%). The incidence of delirium was 22.9%. The mortality among all subjects was 15.6%; the mortality rate in patients who developed delirium was 12%. The only variable that had an association with the development of delirium in the ICU was the days of use of mechanical ventilation (OR: 1.06; CI 95%: 0.99–1.13;p=0.07). Conclusion. Delirium is a frequent condition in critically ill cancer patients admitted to the ICU. The duration in days of mechanical ventilation is potential risk factors for developing delirium during an ICU stay. Delirium was not associated with a higher rate of mortality in this group of patients.

Confusion Assessment Method for the Intensive Care Unit

2001 ◽  
Author(s):  
E. Wesley Ely ◽  
Sharon K. Inouye ◽  
Gordon R. Bernard ◽  
Joseph Francis ◽  
Lisa May ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment

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.

Serum protein S100 as marker of postoperative delirium after off-pump coronary artery bypass surgery: secondary analysis of two prospective randomized controlled trials

2016 ◽  
Vol 54 (10) ◽  
Author(s):  
Layth Al Tmimi ◽  
Marc Van de Velde ◽  
Bart Meyns ◽  
Bart Meuris ◽  
Paul Sergeant ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Postoperative Delirium ◽  
Artery Bypass ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Off Pump ◽  
Confusion Assessment ◽  
Opcab Surgery ◽  
Pump Coronary Artery Bypass

AbstractBackground:To investigate the predictive value of S100 (biochemical marker of neuroglial injury) for the occurrence of postoperative delirium (POD) in patients undergoing off-pump coronary artery bypass (OPCAB)-surgery.Methods:We enrolled 92 patients older than 18 years undergoing elective OPCAB-surgery. Serum-levels of S100 were determined at baseline (BL), end of surgery (EOS) and on the first postoperative day (PD1). Postoperatively, all-patients were evaluated daily until PD5 for the presence of POD using the confusion assessment method (CAM) or the confusion assessment method for the intensive care unit (CAM-ICU) for patients in the intensive care unit (ICU).Results:The overall incidence of POD was 21%. S100-values on PD1 significantly predicted the occurrence of POD during the later hospital stay [area under the curve (AUC)=0.724 (95% confidence interval (CI): 0.619–0.814); p=0.0001] with an optimal cut-off level of 123 pg mLConclusions:S100-levels <123 pg mL

Delirium in Postoperative Patients Admitted to the Intensive Care Unit

2018 ◽  
Vol 84 (6) ◽  
pp. 875-880
Author(s):  
Timothy R. Romanauski ◽  
Erin E. Martin ◽  
Juraj Sprung ◽  
David P. Martin ◽  
Darrell R. Schroeder ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Electronic Health Records ◽  
Assessment Method ◽  
Chronic Health Evaluation ◽  
Surgical Patients ◽  
Health Evaluation ◽  
Health Records ◽  
Chronic Health ◽  
Electronic Health

Postoperative delirium (POD) is common among surgical patients admitted to the intensive care unit (ICU) and is associated with increased resource utilization, morbidity, and death. Our primary aim was to compare rates of POD using administrative International Classification of Diseases, Ninth Revision, records and automated interrogation of electronic health records from Confusion Assessment Method for the ICU (CAM-ICU) screening. The secondary aim was to assess POD risk associated with patient and perioperative characteristics. Electronic health records of surgical patients admitted to the ICU during 2011 through 2014 were abstracted for POD assessment by CAM-ICU and by administrative codes, Charlson comorbidity index, surgical characteristics, and Acute Physiology, Age, Chronic Health Evaluation III scores. Of 6338 patients, CAM-ICU identified 606 (9.6%) and administrative records identified 55 (0.9%) POD cases, with agreement on 50 cases. In multivariable logistic regression based on POD identified with CAM-ICU, preexisting dementia had the strongest association with POD (odds ratio [95% confidence interval], 6.47 [3.68–11.37]; P < 0.001). Other associations found were older age, congestive heart failure, chronic pulmonary disease, increased surgical duration, emergency cases, blood transfusions, postoperative ventilation, and higher Acute Physiology, Age, Chronic Health Evaluation III scores (all P ≤ 0.01). POD cases had lengthier ICU and hospital stays and a higher mortality rate (all P < 0.001). CAM-ICU scores identified higher rates of POD than a search for POD based on administrative codes. Preoperative presence of dementia and major comorbidities were associated with POD. Delirium in surgical patients is associated with worse outcomes.

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