Delirium

2019 ◽  
Author(s):  
Sarah Wagner ◽  
Robert Gerstman
Keyword(s):  
Health Care Cost ◽  
Length Of Hospital Stay ◽  
Altered Mental Status ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Medical Illness ◽  
Richmond Agitation Sedation Scale ◽  
The Past ◽  
Short Period ◽  
Brain Failure

Delirium is a disturbance of attention and awareness, which develops over a short period of time. It is a change in a person’s baseline and fluctuates throughout the course of the day.1 Delirium can accompany almost any serious medical illness. It is an independent risk factor for increasing a person’s morbidity and mortality. Delirium is associated with an increased length of hospital stay and an increase in health care cost.2 There is growing literature to assist in the diagnosing and treatment of patients with delirium. This article dives into the recent research addressing the pharmacologic and nonpharmacologic methods to treat delirium. Various pharmacologic interventions have been studied over the past several years including the use of melatonin, ramelteon, dexmedetomidine, and antipsychotics. This review contains 2 tables and 17 references. Key Words: acute brain failure, altered mental status, Confusion Assessment Method, critical care, delirium, encephalopathy, ICU, RASS, Richmond Agitation-Sedation Scale

Sedation in the Intensive Care Setting

2019 ◽  
Author(s):  
William John Wallisch IV ◽  
Ata Murat Kaynar
Keyword(s):  
Care Setting ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
Intensive Care Setting ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Confusion Assessment ◽  
The Past ◽  
Sedation Program

The recent clinical trials on sedation and delirium in the ICU shifted the scales dramatically in the past 10 to 20 years and less sedation is now the accepted norm with titration goals. Now the art of sedation is in the hands of the clinicians to achieve a balance between alleviation of pain and anxiety while keeping patients calm, cooperative, and part of daily activities in the ICU. In this chapter we summarize the various assessment tools for optimal sedation in the ICU as well as the medications used to achieve sedation. However, the clinicians should not forget the nonpharmacologic approaches such as prevention of sleep interruption as part of a successful comprehensive sedation program in the ICU. This review contains 3 tables, and 22 references. Key Words: confusion assessment method, delirium, dexmedetomidine, etomidate, fentanyl, GABA, ketamine, propofol, Richmond agitation-sedation scale (RASS), sedation-agitation scale (SAS)

Sedation in the Intensive Care Setting

2019 ◽  
Author(s):  
William John Wallisch IV ◽  
Ata Murat Kaynar
Keyword(s):  
Care Setting ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
Intensive Care Setting ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Confusion Assessment ◽  
The Past ◽  
Sedation Program

The recent clinical trials on sedation and delirium in the ICU shifted the scales dramatically in the past 10 to 20 years and less sedation is now the accepted norm with titration goals. Now the art of sedation is in the hands of the clinicians to achieve a balance between alleviation of pain and anxiety while keeping patients calm, cooperative, and part of daily activities in the ICU. In this chapter we summarize the various assessment tools for optimal sedation in the ICU as well as the medications used to achieve sedation. However, the clinicians should not forget the nonpharmacologic approaches such as prevention of sleep interruption as part of a successful comprehensive sedation program in the ICU. This review contains 3 tables, and 22 references. Key Words: confusion assessment method, delirium, dexmedetomidine, etomidate, fentanyl, GABA, ketamine, propofol, Richmond agitation-sedation scale (RASS), sedation-agitation scale (SAS)

Sedation in the Intensive Care Setting

2019 ◽  
Author(s):  
William John Wallisch IV ◽  
Ata Murat Kaynar
Keyword(s):  
Care Setting ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
Intensive Care Setting ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Confusion Assessment ◽  
The Past ◽  
Sedation Program

The recent clinical trials on sedation and delirium in the ICU shifted the scales dramatically in the past 10 to 20 years and less sedation is now the accepted norm with titration goals. Now the art of sedation is in the hands of the clinicians to achieve a balance between alleviation of pain and anxiety while keeping patients calm, cooperative, and part of daily activities in the ICU. In this chapter we summarize the various assessment tools for optimal sedation in the ICU as well as the medications used to achieve sedation. However, the clinicians should not forget the nonpharmacologic approaches such as prevention of sleep interruption as part of a successful comprehensive sedation program in the ICU. This review contains 3 tables, and 22 references. Key Words: confusion assessment method, delirium, dexmedetomidine, etomidate, fentanyl, GABA, ketamine, propofol, Richmond agitation-sedation scale (RASS), sedation-agitation scale (SAS)

Sedation in the Intensive Care Setting

2019 ◽  
Author(s):  
William John Wallisch IV ◽  
Ata Murat Kaynar
Keyword(s):  
Care Setting ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
Intensive Care Setting ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Confusion Assessment ◽  
The Past ◽  
Sedation Program

The recent clinical trials on sedation and delirium in the ICU shifted the scales dramatically in the past 10 to 20 years and less sedation is now the accepted norm with titration goals. Now the art of sedation is in the hands of the clinicians to achieve a balance between alleviation of pain and anxiety while keeping patients calm, cooperative, and part of daily activities in the ICU. In this chapter we summarize the various assessment tools for optimal sedation in the ICU as well as the medications used to achieve sedation. However, the clinicians should not forget the nonpharmacologic approaches such as prevention of sleep interruption as part of a successful comprehensive sedation program in the ICU. This review contains 3 tables, and 22 references. Key Words: confusion assessment method, delirium, dexmedetomidine, etomidate, fentanyl, GABA, ketamine, propofol, Richmond agitation-sedation scale (RASS), sedation-agitation scale (SAS)

scholarly journals “SQiD, the Single Question in Delirium; can a single question help clinicians to detect delirium in hospitalised cancer patients?” running heading Single Question in Delirium” (Bcan-D-20-01665)

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Megan B. Sands ◽  
Swapnil Sharma ◽  
Lindsay Carpenter ◽  
Andrew Hartshorn ◽  
Jessica T. Lee ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Clinical Care ◽  
Length Of Hospital Stay ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Clinical Staff ◽  
Screening Tools ◽  
Diagnostic Values ◽  
D 20 ◽  
Single Question

Abstract Aim A serious syndrome for cancer in-patients, delirium risk increases with age and medical acuity. Screening tools exist but detection is frequently delayed or missed. We test the ‘Single Question in Delirium’ (SQiD), in comparison to psychiatrist clinical interview. Methods Inpatients in two comprehensive cancer centres were prospectively screened. Clinical staff asked informants to respond to the SQiD: “Do you feel that [patient’s name] has been more confused lately?”. The primary endpoint was negative predictive value (NPV) of the SQiD versus psychiatrist diagnosis (Diagnostic and Statistics Manual criteria). Secondary endpoints included: NPV of the Confusion Assessment Method (CAM), sensitivity, specificity and Cohen’s Kappa coefficient. Results Between May 2012 and July 2015, the SQiD plus CAM was applied to 122 patients; 73 had the SQiD and psychiatrist interview. Median age was 65 yrs. (interquartile range 54–74), 46% were female; median length of hospital stay was 12 days (5–18 days). Major cancer types were lung (19%), gastric or other upper GI (15%) and breast (14%). 70% of participants had stage 4 cancer. Diagnostic values were similar between the SQiD (NPV = 74, 95% CI 67–81; kappa = 0.32) and CAM (NPV = 72, 95% CI 67–77, kappa = 0.32), compared with psychiatrist interview. Overall the CAM identified only a small number of delirious cases but all were true positives. The specificity of the SQiD was 87% (74–95) The SQiD had higher sensitivity than CAM (44% [95% CI 41–80] vs 26% [10–48]). Conclusion The SQiD, administered by bedside clinical staff, was feasible and its psychometric properties are now better understood. The SQiD can contribute to delirium detection and clinical care for hospitalised cancer patients.

Agitation

2018 ◽  
pp. 180-183
Author(s):  
Megan Rashid
Keyword(s):  
Correct Diagnosis ◽  
Altered Mental Status ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Early Mobility ◽  
Confusion Assessment ◽  
Life Threatening ◽  
High Risk Populations ◽  
Icu Delirium ◽  
Abcdef Bundle

The case illustrates a classic example of intensive care unit (ICU) delirium, which often goes unrecognized but can adversely affect both morbidity and mortality. The Confusion Assessment Method for the ICU (CAM-ICU) is a validated tool for diagnosing delirium, but it remains a diagnosis of exclusion, and it is important to rule out potentially life-threatening medical causes of altered mental status. Treatment is difficult even with the correct diagnosis, and prevention is key. The ABCDEF bundle (assessing and managing pain, both SAT and SBT, choice of analgesia/sedation, delirium, early mobility, and family engagement) is a tool that identifies high-risk populations, and can help mitigate the prevalence of ICU delirium.

scholarly journals Assessment of Delirium Using the Confusion Assessment Method in Older Adult Inpatients in Malaysia

Geriatrics ◽  
2019 ◽  
Vol 4 (3) ◽  
pp. 52
Author(s):  
Khor ◽  
Ong ◽  
Tan ◽  
Low ◽  
Saedon ◽  
...  
Keyword(s):  
Older Patients ◽  
Altered Mental Status ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
University Hospital ◽  
Cognitive Screening ◽  
Cross Sectional ◽  
Confusion Assessment ◽  
Severity Scores

The detection of delirium in acutely ill older patients is challenging with the lack of informants and the necessity to identify subtle and fluctuating signs. We conducted a cross-sectional study among older patients admitted to a university hospital in Malaysia to determine the presence, characteristics, and mortality outcomes of delirium. Consecutive patients aged ≥65years admitted to acute medical wards were recruited from August to September 2016. Cognitive screening was performed using the mini-mental test examination (MMSE) and the Confusion Assessment Method (CAM). The CAM-Severity (CAM-S) score was also performed in all patients. Of 161 patients recruited, 43 (26.7%) had delirium. At least one feature of delirium from the CAM-S short and long severity scores were present in 48.4% and 67.1%, respectively. Older age (OR: 1.07, 95% CI: 1.01–1.14), immobility (OR: 3.16, 95% CI: 1.18–8.50), cognitive impairment (OR: 5.04, 95% CI: 2.07–12.24), and malnutrition (OR: 3.37; 95% CI: 1.15–9.85) were significantly associated with delirium. Older patients with delirium had a higher risk of mortality (OR: 7.87, 95% CI: 2.42–25.57). Delirium is common among older patients in our setting. A large proportion of patients had altered mental status on admission to hospital although they did not fulfill the CAM criteria of delirium. This should prompt further studies on strategies to identify delirium and the use of newer, more appropriate assessment tools in this group of vulnerable individuals.

scholarly journals Time of delirium onset and prognosis amongst Southern Brazilian hospitalized elderly patients

2009 ◽  
Vol 3 (4) ◽  
pp. 303-307
Author(s):  
André Luiz Moschetta ◽  
Carine Volkweis Silveira ◽  
Roberta Rigo Dalacorte ◽  
Rodolfo Herberto Schneider ◽  
Irênio Gomes da Silva Filho
Keyword(s):  
Protective Factor ◽  
Average Length ◽  
Prognostic Significance ◽  
Length Of Hospital Stay ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Historical Cohort ◽  
Hospitalized Elderly ◽  
Hospitalized Elderly Patients ◽  
The Relationship

Abstract The prognostic significance of delirium in hospitalized elderly has not yet been fully clarified. Objectives: The present study was designed to evaluate the relationship between prevalent delirium (PrD), incident delirium (InD) and final outcome. Methods: A historical cohort of 261 patients was selected. delirium was diagnosed using the Confusion Assessment Method. Results: The total frequency of delirium detected was 42.5%-31.4% PrD and 16.2% InD. Among patients with InD, the average length of hospital stay was 9.1 days longer than for patients without delirium (p=0.002), and the hospital mortality associated with InD was 48% versus 2.7% for those without delirium (p<0.001). However, no difference was observed between patients with PrD and those without delirium. Conclusions: These results suggest that, when investigating delirium and prognosis amongst hospitalized elderly, it is fundamental to differentiate in terms of time of onset. Furthermore, the absence of delirium seems to be an important protective factor.

scholarly journals The Prevalence of Delirium in An Older Acute Surgical Population and Its Effect on Outcome

Geriatrics ◽  
2019 ◽  
Vol 4 (4) ◽  
pp. 57 ◽  
Author(s):  
Hewitt ◽  
Owen ◽  
Carter ◽  
Stechman ◽  
Tay ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Ageing Population ◽  
Multi Centre Study ◽  
Logistic Regression Models ◽  
Surgical Units

Background: With an ageing population, an increasing number of older adults are admitted for assessment to acute surgical units. Older adults have specific factors that may influence outcomes, one of which is delirium (acute cognitive impairment). Objectives: To establish the prevalence of delirium on admission in an older acute surgical population and its effect on mortality. Secondary outcomes investigated include hospital readmission and length of hospital stay. Method: This observational multi-centre study investigated consecutive patients, ≥65 years, admitted to the acute surgical units of five UK hospitals during an eight-week period. On admission the Confusion Assessment Method (CAM) score was performed to detect delirium. The effect of delirium on important clinical outcomes was investigated using tests of association and logistic regression models. Results: The cohort consisted of 411 patients with a mean age of 77.3 years (SD 8.1). The prevalence of admission delirium was 8.8% (95% CI 6.2–11.9%) and cognitive impairment was 70.3% (95% CI 65.6–74.7%). The delirious group were not more likely to die at 30 or 90 days (OR 1.1, 95% CI 0.2 to 5.1, p = 0.67; OR 1.4, 95% CI 0.4 to 4.1. p = 0.82) or to be readmitted within 30 days of discharge (OR 0.9, 95% CI 0.4 to 2.2, p = 0.89). Length of hospital stay was significantly longer in the delirious group (median 8 vs. 5 days respectively, p = 0.009). Conclusion: Admission delirium occurs in just under 10% of older people admitted to acute surgical units, resulting in significantly longer hospital stays.

scholarly journals Ação de fármacos sedativos para o desenvolvimento de delirium e perfil funcional de pacientes internados em unidades de terapia intensiva

2021 ◽  
Vol 10 (3) ◽  
pp. e45410313588
Author(s):  
Anne Karine Menezes Santos Batista ◽  
Tais Santana Barbosa ◽  
Phydel Palmeira Carvalho ◽  
Natasha Cordeiro dos Santos ◽  
Victor Durier Cavalcanti de Almeida ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Confusion Assessment ◽  
Status Score ◽  
Terapia Intensiva

Introdução: Os sedativos são fármacos utilizados como auxiliares terapêuticos em pacientes sob cuidados intensivos. Dentre os possíveis desfechos controversos ao seu uso, as alterações cognitivas são pontuadas na literatura, com a encefalopatia aguda ou delirium, sendo a mais descrita. Objetivos: Avaliar a associação entre o uso de fármacos com ação sedativa para o desenvolvimento de delirium e caracterizar o perfil funcional dos indivíduos com delirium. Material e métodos: Estudo longitudinal, realizado em um hospital público da rede estadual, durante os meses de junho de 2019 a outubro (primeira quinzena) de 2020, com indivíduos acima de 18 anos, internados em unidades de terapia intensiva e enfermarias, por meio de escalas para avaliação de sedação, delirium e funcionalidade (Richmond Agitation Sedation Scale - RASS, Confusion Assessment Method for the Intensive Care Unit - CAM-ICU e Status Score for the Intensive Care Unit - FSS, respectivamente), com capacidade de verbalização e sem admissão via transferência externa. Resultados: Inclusos 104 pacientes com idade média de 59,7 ± 15,3 anos, sendo 53,2% do sexo masculino, com 49% sendo hipertensos e 79,8% negando tabagismo. Não houve significância estatística entre os fármacos sedativos para o desencadeamento de delirium. A maioria dos pacientes com delirium estavam no intervalo da FSS entre 0-15 no ambiente intensivo e 16-25 nas enfermarias. Considerações finais: Não há associação entre o uso de fármacos com ação sedativa e delirium. Houve alteração do perfil funcional, com os pacientes tornando-se dependentes moderados a máximos nas unidades intensivas e dependentes mínimos ou independentes nas enfermarias.

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