Development, Implementation, and Outcomes of a Delirium Protocol in the Surgical Trauma Intensive Care Unit

Sullinger, Danine; Gilmer, Alexander; Jurado, Lesly; Zimmerman, Lisa Hall; Steelman, Joshua; Gallagher, A C; Dupre, Tiffany; Acquista, Elizabeth

doi:10.1177/1060028016668627

Cited by 15 publications

(28 citation statements)

References 20 publications

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“…The length of hospital stays among patients with delirium was four days longer on average, and ICU stay lengths 24 hours longer, than for patients without delirium. Other studies on postoperative delirium have shown that the average length of stay for spine surgery patients was three days or longer [6,8,10], the average for hip surgery patients was two days or longer [9], the average for cardiac surgery patients was four days or longer [12], the average for acute care surgery patients was seven days or longer [4], and the average for surgical trauma ICU and major surgery patients was four days or longer [21,22]. The length of hospital stays tends to increase with post-operative delirium status.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Delirium is Associated with Negative Outcomes and Long-Term Mortality in Elderly Koreans: A Retrospective Observational Study

Park

Kim

2019

Medicina

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Background and objectives: Delirium is an acute state that causes confusion and occurs frequently after surgery in elderly patients. Delirium is also related to various clinical complications. With increasing numbers of surgeries performed on elderly Koreans, the number of cases of delirium and associated complications will likely rise. The purpose of the present study was to determine whether postoperative delirium in elderly Korean patients negatively influenced other clinical outcomes and their long-term mortality. Materials and Methods: The medical records of 1016 elderly patients (65 years or older) who underwent major abdominal surgery from January 2014 to December 2016 were retrospectively investigated. To determine long-term mortality, patients were followed for up to 12 months post-operation. Results: Delirium occurred in 194 patients (18.3%). Postoperative delirium was significantly associated with the length of hospital stay (B = 2.72), length of ICU stay (B = 18.78), adverse medical events (OR = 2.26, CI = 1.45–3.52), reoperation (OR = 5.50, CI = 1.66–18.22), ICU readmission (OR = 14.10, CI = 2.97–66.90), medical costs (B = 2473.85), discharge to somewhere other than the patient’s home (OR = 6.01, CI = 3.35–10.76), hospital readmission (OR = 2.73, CI = 1.45–5.14), in-hospital mortality (OR = 3.34, CI = 1.21–9.19), three-month mortality (HR = 3.22, CI = 1.27–8.14), six-month mortality (HR = 2.85, CI = 1.28–6.36), and 12-month mortality (HR = 2.19, CI = 1.10–4.32). Conclusions: Postoperative delirium in elderly Korean patients was associated with negative clinical outcomes and mortality. For rapid recovery and increased survival rates in surgical patients, effective delirium-prevention care and active delirium treatments are necessary.

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Section: Discussionmentioning

confidence: 99%

Postoperative Delirium is Associated with Negative Outcomes and Long-Term Mortality in Elderly Koreans: A Retrospective Observational Study

Park

Kim

2019

Medicina

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“…Of the 27 included studies, 11 were RCTs or randomized pilot studies [21, 28, 29, 31-33, 35, 39-41, 45], eight were pre-post prospective studies [23,25,36,37,43,44,46,47], two were quasi-experimental [22,27], and the remaining six were a case-matched control study, an evidence based protocol, a mixedmethods pilot study, a prospective cohort study, a retrospective cohort study, and an action research study [24,26,30,34,38,42].…”

Section: Resultsmentioning

confidence: 99%

“…The remaining nine bundle studies developed new, unique bundles. They included four pre-post studies [25,43,46,47], three RCTs [32,33,40], one quasi-experimental study [22], and one action research study [30]. Seven assessed delirium incidence and duration using CAM-ICU [22,25,30,32,40,46,47], one used NEECHAM [33], and one used ICDSC [43].…”

Section: Other Bundled Protocolsmentioning

confidence: 99%

“…Sullinger et al enrolled critically ill patients with acute delirium in a pre-post retrospective study, tailoring their bundle to incorporate staff education with sensory aids, healing arts techniques, mobility, environmental changes, and family presence [46]. Their bundle also included the initiation of antipsychotic medications if non-pharmacologic tactics failed.…”

Section: And 4)mentioning

confidence: 99%

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The Effect of Non-Pharmacologic Strategies on Prevention or Management of Intensive Care Unit Delirium: A Systematic Review

Hashemighouchani

Cupka

Lipori

et al. 2020

Preprint

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Objective: The aim of this systematic review is to examine and report on recently available literature evaluating the relationship between non-pharmacologic interventions and the reduction of delirium in the intensive care unit. Methods: Six major research databases were systematically searched for articles analyzing the efficacy of non-pharmacologic delirium interventions in the past five years. Search results were restricted to adult human patients aged 18 years or older in the intensive care unit setting, excluding terminally ill subjects and withdrawal-related delirium. Following title, abstract, and full text review, 27 articles fulfilled the inclusion criteria and are included in this report. Results: The 27 reviewed articles consist of 12 interventions with a single-component investigational approach, and 15 with multi-component bundled protocols. Delirium incidence was the most assessed outcome followed by duration. Family visitation was the most effective individual intervention and mobility interventions were the least effective. Two of the three family studies significantly reduced delirium incidence, while one in five mobility studies did the same. Multi-component bundle approaches were the most effective of all; of the reviewed studies, eight of 11 bundles significantly improved delirium incidence and seven of eight bundles decreased the duration of delirium. Conclusions: Multi-component, bundled interventions were more effective at managing intensive care unit delirium than those utilizing an approach with a single interventional element. Although better management of this condition suggests a decrease in resource burden and improvement in patient outcomes, comparative research should be performed to identify the importance of specific bundle elements.

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“…Cardiac effects are rare where cumulative daily doses of intravenous haloperidol are lower than 2 mg, unless patients have additional risk factors for QTc prolongation (Meyer‐Massetti et al, ). Studies indicate significant benefit where care of delirious patients is protocolised to include dose titration with regular monitoring of arousal, cardiac status and for EPS (Skrobik et al, ; Dale et al, ; Sullinger et al, ). However, implementation is challenging—a survey of ICU specialists found that QTc monitoring was highly variable, not routinely measured in 20% of ICUs and haloperidol continued in 60% cases where QTc interval exceeded 500 ms (Devlin et al, ).…”

Section: Introductionmentioning

confidence: 99%

Debate article: Antipsychotic medications are clinically useful for the treatment of delirium

Meagher

Agar

Teodorczuk

2017

Int J Geriat Psychiatry

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Prescribing of antipsychotic medications for patients with delirium remains controversial. Concerns exist that these vulnerable and frail patients may be prescribed antipsychotics inappropriately as a substitute for non-pharmacological approaches when identifiable causes are not found or they challenge ward processes. Moreover, recent evidence suggests that antipsychotics may cause more harm than good in the palliative care patient group with delirium. On the other hand, guidelines in the United Kingdom and the Netherlands support prescribing of antipsychotics in certain circumstances, and a large European survey has revealed that antipsychotics tend to be prescribed first line for hyperactive delirium. Never before, therefore, is there a greater need to examine whether indeed these medications are clinically useful for the treatment of delirium. With this in mind, evidence-based arguments for and against prescribing antipsychotics for the treatment of delirium are presented in this debate article. The paper concludes with a moderation piece to help guide clinical practice.

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Development, Implementation, and Outcomes of a Delirium Protocol in the Surgical Trauma Intensive Care Unit

Cited by 15 publications

References 20 publications

Postoperative Delirium is Associated with Negative Outcomes and Long-Term Mortality in Elderly Koreans: A Retrospective Observational Study

Postoperative Delirium is Associated with Negative Outcomes and Long-Term Mortality in Elderly Koreans: A Retrospective Observational Study

The Effect of Non-Pharmacologic Strategies on Prevention or Management of Intensive Care Unit Delirium: A Systematic Review

Debate article: Antipsychotic medications are clinically useful for the treatment of delirium

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