Delirium in intensive care: A stepped-wedge cluster randomised controlled trial for a nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the intensive care unit (protocol)

Lynch, Joan; Rolls, Kaye; Hou, Yuchin; Hedges, Sonja; Sayfe, Masar Al; Shunker, Sharon-Ann; Brennan, Kathleen; Sánchez, David Martí; Bogdanovski, Tony; Hunt, Leanne; Alexandrou, Evan; Frost, Steven A.

doi:10.1016/j.aucc.2019.12.003

Cited by 11 publications

(8 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study of the relationship between clinical frailty, delirium and hospital mortality is part of a larger, nurseled interventional study, to reduce the burden of delirium in the adult ICU setting, which has been described previously [15]. In brief, the Delirium in ICU (Deli) Study is a randomised stepped-wedge intervention trial, including the four adult intensive care units across the South Western Sydney Local Health District (SWSLHD).…”

Section: Methodsmentioning

confidence: 99%

“…The sample size planned for the overall baseline and intervention phase of the Deli Study was based on monthly admissions between 80 and 125 (adults, aged 16 years or more) patients from the four ICUs included in the 12-month study [15]. Our local health district ICU data estimated approximately 80% of admissions were among patients aged 50 years or more and that after application of the inclusion and exclusion criteria, approximately 70% of admissions would be included in our study.…”

Section: Sample Sizementioning

confidence: 99%

See 1 more Smart Citation

Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods This study is part of a Delirium in Intensive Care (Deli) Study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50 years or more; acute episodes of delirium; and the outcomes of intensive care and hospital stay were explored. Results During the 6-month baseline period, 997 patients, aged 50 years or more, were included in this study. The average age was 71 years (IQR, 63–79); 55% were male (n = 537). Among these patients, 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted rate ratio (adjRR) = 1.71, 95% confidence interval (CI) 1.20–2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009) and had a higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72–3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality versus 10% among non-frail patients who also experienced delirium in the ICU. Conclusion Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it is important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium and, importantly, to discuss these issues in an open and empathetic way with the patient and their families.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Sample Sizementioning

confidence: 99%

Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…This study of the relationship between clinical frailty, delirium and hospital mortality is part of a larger, nurse-led interventional study, to reduce the burden of delirium in the adult ICU setting, which has been described previously (Lynch et al, 2020). In brief, the Delirium in ICU (Deli) Study in a randomised stepped-wedge intervention trial, including the four adult intensive care units across the South Western Sydney Local Health District (SWSLHD).…”

Section: Methodsmentioning

confidence: 99%

“…The sample size planned for the overall baseline and intervention phase of the Deli study was based on monthly admissions between 80 and 125 (adults, aged 16-years or more) patients from the four ICUs included in the 12-month study (Lynch et al, 2020). Our, local health district ICU data estimated approximately 80% of admissions was among patients aged 50-year or more, and that after application of the inclusion and exclusion criteria, approximately 70% of admissions would be included in our study.…”

Section: Sample Sizementioning

confidence: 99%

Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.

Sánchez

Brennan

Safye³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care.Methods: This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the SWSLHD between May 1st 2019 and the end of April 2020. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay will be described.Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.71, 95% Confidence Interval (CI) 1.20 – 2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72 – 3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU.Conclusion: We have been able to show that among older frail admissions to intensive care, not just delirium, but hospital mortality is high. Importantly, we have found that approximately one in three frail patients who experienced an acute episode of delirium during their stay in the intensive care did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the intensive care setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.

show abstract

“…This study of the relationship between clinical frailty, delirium and hospital mortality is part of a larger nurse-led interventional study to reduce the burden of delirium in the adult ICU setting, which has been described previously (Lynch et al, 2020). In brief, the Delirium in ICU (Deli) Study in a randomised stepped-wedge intervention trial, including the four adult intensive care units across the South Western Sydney Local Health District.…”

Section: Methodsmentioning

confidence: 99%

Frailty, delirium and hospital mortality of older adults admitted to intensive care, a mediation analysis: the Delirium (Deli) in ICU study.

Sánchez¹,

Brennan²,

Safye³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of frail patients an acute episode of delirium is also common, and both frailty and delirium increase the risk of mortality. However, the complex relationship between frailty, delirium and mortality has not been extensively explored in the intensive care setting. Therefore, the aim of this study was to explore the relationship between clinical frailty, acute delirium and hospital mortality of older adults admitted to intensive care. Methods This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the South Western Sydney Local Health District, between May 2019 and April 2020. During the initial 6-month baseline period, clinical frailty status on admission to ICU, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of ICU and hospital stay will be described. Mediation analysis was used to assess the relationship between frailty, delirium and risk of hospital death. Results During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63–79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.61, 95% Confidence Interval (CI) 1.14–2.28, p = 0.007), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.43, 95% CI 1.68–3.57, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the ICU had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU (p = 0.034, for interaction between frailty, delirium and hospital mortality). The proportion of the effect of frailty and risk of hospital mortality mediated by an acute episode of delirium in the ICU was estimated to 9.4% (95% CI 2–24%). Conclusion This study has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the ICU did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the ICU setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.

show abstract

Delirium in intensive care: A stepped-wedge cluster randomised controlled trial for a nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the intensive care unit (protocol)

Cited by 11 publications

References 52 publications

Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study

Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study

Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.

Frailty, delirium and hospital mortality of older adults admitted to intensive care, a mediation analysis: the Delirium (Deli) in ICU study.

Contact Info

Product

Resources

About