Assessment of delirium in the intensive care unit

Kallenbach, TF; Amado, LA

doi:10.1080/22201181.2017.1332809

Cited by 5 publications

(7 citation statements)

References 64 publications

(148 reference statements)

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“…Although the aim of this SR is not to explore professionals’ decision making, diagnosis, and instruments used for the early detection of delirium, the results showed that this syndrome is often misdiagnosed [ 1 , 5 , 13 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

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Nursing Intervention to Prevent and Manage Delirium in Critically Ill Patients: A Scoping Review

Fernandes,

Santos,

Anacleto

et al. 2024

Healthcare

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Delirium is an acute neuropsychiatric syndrome of multifactorial etiology with a high incidence in people admitted to intensive care units. In addition to reversible impairment of cognitive processes, it may be associated with changes in thinking and perception. If, in the past, it was considered an expected complication of severe disease, nowadays, delirium is associated with a poor short-term and long-term prognosis. Knowing that its prevention and early identification can reduce morbidity, mortality, and health costs, it is vital to investigate nursing interventions focused on delirium in critically ill patients. This study aimed to identify nursing interventions in the prevention and management of delirium in critically ill adults. The method used to answer the research question was a scoping review. The literature search was performed in the Medline (via PubMed), CINAHL (via EBSCOhost), Scopus, Web of Science, and JBI databases. The final sample included 15 articles. Several categories of non-pharmacological interventions were identified, addressing the modifiable risk factors that contribute to the development of delirium, and for which nurses have a privileged position in their minimization. No drug agent can, by itself, prevent or treat delirium. However, psychoactive drugs are justified to control hyperactive behaviors through cautious use. Early diagnosis, prevention, or treatment can reduce symptoms and improve the individual’s quality of life. Therefore, nursing professionals must ensure harmonious coordination between non-pharmacological and pharmacological strategies.

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Section: Discussionmentioning

confidence: 99%

“…Timely diagnosis and management may curtail the duration and associated morbidity and mortality of delirium [ 36 ] or even reverse symptoms and give the critically ill individual a better quality of life, avoiding prolonged hospitalizations and/or other comorbidities [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Nursing Intervention to Prevent and Manage Delirium in Critically Ill Patients: A Scoping Review

Fernandes,

Santos,

Anacleto

et al. 2024

Healthcare

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“…The incidence of delirium varies widely from 16.1% to 83.3% in ICU patients, especially among those undergoing mechanical ventilation (60–80%) . The variable incidence is due to: different patient baseline characteristics; types of ICU (medical, surgical or both); illness severity; screening tools for diagnosis of delirium; and concomitant medications .…”

Section: Discussionmentioning

confidence: 99%

The effect of dexmedetomidine on delirium and agitation in patients in intensive care: systematic review and meta‐analysis with trial sequential analysis

Shubash

Chong

2018

Anaesthesia

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Delirium is common in intensive care patients. Dexmedetomidine is increasingly used for sedation in this setting, but its effect on delirium remains unclear. The primary aim of this review was to examine whether dexmedetomidine reduces the incidence of delirium and agitation in intensive care patients. We sought randomised clinical trials in MEDLINE, EMBASE, PubMed and CENTRAL from their inception until June 2018. Observational studies, case reports, case series and non-systematic reviews were excluded. Twenty-five trials including 3240 patients were eligible for inclusion in the data synthesis. In the patients who received dexmedetomidine (eight trials, 1425 patients), delirium was reduced, odds ratio (95%CI) 0.36 (0.26-0.51), p < 0.001 and high quality of evidence. The use of dexmedetomidine was associated with a reduced incidence of agitation, OR (95%CI) 0.34 (0.20-0.59), p < 0.001, moderate quality of evidence. Patients who were randomly assigned to dexmedetomidine had a significantly higher incidence of bradycardia, OR (95%CI) 2.18 (1.46-3.24), p < 0.001, moderate quality of evidence; and hypotension, OR (95%CI) 1.89 (1.48-2.41), p < 0.001, high quality of evidence. We found no evidence of an effect on mortality, OR (95%CI) 0.86 (0.66-1.10), p = 0.23, moderate quality of evidence. The trial sequential analyses for the incidence of delirium, bradycardia and hypotension was conclusive but not for the incidence of agitation and mortality. In summary, this meta-analysis suggests that dexmedetomidine reduces the incidence of delirium and agitation in intensive care patients. The general quality of evidence ranged from moderate to high.

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“…Bendras jautrumas 95-100 procentų; ventiliuojamiems pacientams jautrumas 92-100 procentų. Bendras specifiškumas 89-93 procentai, ventiliuojamiems pacientams 88-100 procentų [25].…”

Section: Tyrimo Rezultataiunclassified

“…Be to, ICDSC lengva įtraukti į kasdienę praktiką, nes įvertinimui naudojami duomenys, kurie ir taip stebimi IT skyriuose. Kitas ICDSC pliusas yra tas, jog galima įvertinti ir subsindrominį delyrą [25], be to, skalė yra jautresnė (99%), lyginant su CAM-ICU, nors specifiškumas (64%) yra ženkliai mažesnis. ICDSC, lyginant su CAM-ICU, geriau numato baigtis, tačiau CAM-ICU yra tinkamesnis ventiliuojamiems pacientams, patikimiau atmeta delyro diagnozę, jeigu jo nėra [30,31].…”

Section: Diskusija Ar Geriausiai Ištirtos Skalės -Geriausias Pasirinkimas?unclassified

Organinio Delyro Hipodiagnostika: Diagnostikos Perspektyvos Lietuvoje

Kersnauskaitė¹,

Kirtiklytė²,

Navickas³

et al. 2021

Health Sciences

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Lietuvoje stebima delyro hipodiagnostikos problema, kurią aiškinti būtų galima bendrosios delyro diagnozavimo taktikos, kurią galėtų taikyti įvairių specialybių gydytojai, nebuvimu. Yra nemažai standartizuotų diagnostikos ir atrankos skalių, kurios naudojamos nustatant delyro diagnozę. Tyrimo tikslas. Išanalizuoti validuotus delyro atrankos ir diagnostikos metodus, plačiausiai taikomus klinikinėje praktikoje. Tyrimo metodika. Atlikta 11 delyro atrankos ir diagnostikos metodų apžvalga; atrinkti metodai lyginti vieni su kitais pagal skalės paskirtį, jautrumą, specifiškumą, vertintoją, vertinimo trukmę ir skalėje vertinamus parametrus. Rezultatai. Iš 11 atrinktų skalių daugiausiai informacijos radome apie NEECHAM (95-97,2% jautrumas ir 78-82,8% specifiškumas), Nu-DESC (85,7% ir 86,8%) ir CAM (46-100% ir 63-100%) metodus. Intensyviosios terapijos pacientams vertinti tinkami penki iš aprašytų metodų: NEECHAM, ICDSC, CAM, CTD ir DDS. Iš jų dažniausiai naudojamos NEECHAM ir CAM (CAM-ICU modifikacija) bei ICDSC. Senyvo amžiaus pacientams labiausiai tinkamos CAM ir Nu-DESC skalės. Dauguma skalių vertina dėmesingumą, orientaciją, sąmonės pokyčius, kalbėjimo ir judesių tikslingumą. Pakartotinis vertinimas reikalingas Nu-DESC, DOSS ir ICDSC metodams. Dauguma skalių, išskyrus ICDSC ir Nu-DESC, neaptinka hipoaktyvios delyro formos. Išvados. Lietuvoje stebima delyro hipodiagnostikos problema, kurią spręsti būtų galima pasitelkiant validuotas delyro stebėsenos ir diagnostikos skales. Intensyviojoje terapijoje patikimiausios delyro vertinimo skalės yra CAM-ICU, ICDSC ir DDS. Senyvo amžiaus pacientams patartina taikyti CAM ir Nu-DESC metodus bei IQCODE klausimyną. Hipoaktyvaus delyro vertinimui geriausiai tinka ICDSC bei Nu-DESC metodai. Vis dėlto, esant delyro atrankos ir diagnostikos skalių įvairovei, išlieka poreikis trumpos, greitai ir paprastai pritaikomos, aukšto jautrumo ir specifiškumo suvienodintos vertinimo skalės, tinkamos įvertinti ne tik delyro faktą, bet ir jo subtipą.

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Assessment of delirium in the intensive care unit

Cited by 5 publications

References 64 publications

Nursing Intervention to Prevent and Manage Delirium in Critically Ill Patients: A Scoping Review

Nursing Intervention to Prevent and Manage Delirium in Critically Ill Patients: A Scoping Review

The effect of dexmedetomidine on delirium and agitation in patients in intensive care: systematic review and meta‐analysis with trial sequential analysis

Organinio Delyro Hipodiagnostika: Diagnostikos Perspektyvos Lietuvoje

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